Neonatal Gastric Volvulus with Dr. Jason Frischer

60% of gastric volvulus cases in the pediatric population happen in the first year of life, with about 21% in the first month.

In a 4-month-old child with gastric volvulus, acute presentation is more likely than chronic.

Key presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube.

A little bit of bloody aspirate from the NG tube and a funny looking stomach bubble on X-ray are key findings in gastric volvulus.

Chronic gastric volvulus is more related to laxity of the gastric ligaments including gastrophrenic, gastrosplenic, gastrocolic, and gastrohepatic ligaments.

Organoaxial volvulus is the first and most common type of gastric volvulus.

In organoaxial volvulus, the stomach spins around an axis drawn between the GE junction and the pylorus, with the greater curvature flipping up and over to become more superior than the lesser curvature.

In mesenteroaxial volvulus, rotation occurs around a line through the middle of the stomach from lesser to greater curvature, with the stomach flipping behind and back over.

In gastric volvulus, when filled with contrast, the pylorus appears right next to or near the GE junction and above the body of the stomach.

On upper GI contrast study in gastric volvulus, contrast probably does not go past the stomach if it makes it into the stomach.

In organoaxial volvulus, if contrast gets past the GE junction into the stomach, the greater curvature appears flipped up.

In mesenteroaxial volvulus, the duodenum may fill above or superior to the GE junction because the pylorus has flipped up and over or behind and over the top of the stomach.

Surgical management of gastric volvulus should be attempted laparoscopically, with the first step being to bring the stomach down from the chest if herniated.

G-tube placement is used to pexy the stomach to the abdominal wall to prevent recurrent twisting in gastric volvulus.

When managing gastric volvulus found during CDH repair, viability of the stomach must always be checked, especially if chronically volvulized or volvulized for a couple of days, by looking at the serosa and blood flow.

In acute gastric volvulus with sudden onset of symptoms, initial management includes securing two good points of IV access and managing the ABCs before proceeding to imaging or surgery.

In an acutely ill infant with suspected gastric volvulus, an urgent upper GI should be obtained while resuscitating, as malrotation is more common and must be differentiated from gastric volvulus.