1 - Serviço de Cirurgia Pediátrica do Hospital Central do Funchal
2 - Serviço de Cirurgia Pediátrica; Hospital de Dona Estefânia, CHULC, EPE
- Publicação – Images in Pediatrics, Portuguese Journal of Pediatrics, Vol. 52, No. 1 (2021):76-7; DOI: https://doi.org/10.25754/pjp.2021.19299
Resumo: A previously healthy 3-year-old female child was referred to the pediatrics outpatient clinic for marked abdominal distension and intermittent generalized abdominal pain presenting in the last few months. She had no nausea, vomiting, anorexia or changes in bowel movements. On physical examination, the patient had a moderately distended and tympanized abdomen, with uncomfortable palpation of all quadrants, without tenderness. Stool tests were negative for parasites. No abnormalities were detected on ultrasound. The upper gastrointestinal contrast study was compatible with chronic organoaxial gastric volvulus. The patient underwent an elective laparoscopic surgery. Intraoperatively, a large stomach without an obvious gastric volvulus associated with a laxity of the gastrohepatic and gastrophrenic ligaments were found. No diaphragmatic or other abdominal organ defects were identified. A gastropexy was performed, by fixing the stomach to the anterior abdominal wall. Surgery went uneventfully and the patient is doing well. Gastric volvulus is a rare cause of pediatric gastrointestinal obstruction characterized by abnormal rotation of part of the stomach on one of its axis: organoaxial (axis between cardia and pylorus), mesenteroaxial (axis between large and small curvatures) or mixed. These types can be categorized as primary/idiopathic or secondary to anatomical defects of adjacent organs. According to its presentation, gastric volvulus is considered to be acute or chronic. In the majority of children with chronic gastric volvulus, the symptoms are frequently non-specific like recurrent nonbilious emesis, epigastric distention, feeding problems, growth failure, recurrent abdominal pain or respiratory symptoms and may resemble other conditions. The upper gastrointestinal contrast study is the diagnostic exam of choice, but the CT scan can be useful in doubtful cases or to detect associated abnormalities. Definitive treatment is surgical reduction of the volvulus, identification and repair of other defects, and gastropexy. Early diagnosis and intervention are essential to a good outcome.
Palavras-Chave: Child, Preschool; Abdominal Pain/etiology; Chronic Disease; Stomach Volvulus/diagnosis