Acute gastric volvulus in children: A systematic review

Abstract

This study aimed to review pediatric cases of acute gastric volvulus, explore the distinguishing features, and outline the diagnosis and management of this life-threatening condition. We searched PubMed, ScienceDirect, and Ovid Medline in March 2018 for cases of gastric volvulus in the pediatric age range (<18 years). Citations that were not published in English, or did not discuss gastric volvulus mainly in its topics, or that it included reports only on cases of adults, or abstract only were excluded from the search. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data on patients age, gender, and presentation of acute or chronic, volvulus-type, clinical presentations, associated pathologies, diagnostic tools, and treatment. We analyzed the data and reported the results in tables and text. There have been 63 cases of gastric volvulus in the pediatric group published in English between 1979 and 2017, with a total of 65 cases by adding our two cases. We divided the 37 acute cases for investigation. Cases ages ranged from newborn to 18-year-old adolescents, with 14 cases (37.8%) in mesenteroaxial axis, 15 cases (40.5%) in organoaxial type, and one in combine type. The most common symptom is emesis, which was counted in 25 cases, with a ratio of 67.6%, abdominal pain or distention in 17 cases (45.9%), and pulmonary symptoms were observed in 10 cases. In the associated pathologies, congenital diaphragmatic hernia (CDH) is the most commonly associated pathology, which was counted in 15 cases (40.5%). Within the 37 cases, 7 cases (18.9%) underwent laparoscopic surgery and 30 cases (81.1%) underwent laparotomy. Gastropexy was performed in 19 cases, and 17 cases underwent a repair of CDH. One case underwent gastric reduction, repair of congenital heart disease, and perforation, but this patient ultimately died of gastric perforation-induced sepsis. Surgical intervention is always applied to an emergency treatment of acute gastric volvulus, and laparoscopic, even single port surgery, is also a choice for these patients.