3 year old child with gastric torsion along the visceral axis

Baby QA (3 years old, in Hanoi ) had severe epigastric pain accompanied by vomiting.

The family took the child to a nearby hospital and was diagnosed with digestive disorders. The child was fasted, given IV fluids, and given an enema, but the symptoms did not improve, and the child's abdominal pain even increased.

Immediately afterwards, the child was taken to the National Children's Hospital for further examination and treatment.

The disease is dangerous. A 3-year-old child has gastric bypass surgery. Figure 1 — Doctors perform laparoscopic surgery (photo TL).

At the National Children's Hospital, Dr. Le Quang Du - Department of Digestive Surgery, General Surgery Center said that baby QA was admitted to the hospital in a state of fussiness, severe epigastric pain, dry heaving, vomiting fluid without bile, and increasing abdominal distension.

Children are actively given intravenous fluids to compensate for water and electrolytes, have a gastric tube inserted, and undergo necessary paraclinical tests to determine the cause of the disease such as ultrasound, endoscopy, X-ray, MRI, 128-slice CT scan, etc.

As a result, the child was diagnosed with intestinal obstruction, dilated stomach, suspected of gastric torsion and emergency surgery was indicated immediately afterwards.

The child's stomach twists 180 degrees around the visceral axis, the stomach rotates along its long axis and becomes blocked, the greater curvature is pushed up and the lesser curvature lies lower in the abdominal cavity.

Doctors urgently untwisted and stitched the stomach to the abdominal wall to prevent future re-twisting.

After nearly two hours of surgery, the child was able to remove the endotracheal tube and breathe completely on his own. Symptoms significantly improved on the second day after surgery, the child no longer had abdominal pain, could eat milk and had normal bowel movements. The child was discharged on the fourth day after surgery.

According to Dr. Tran Anh Quynh - Head of the Department of Digestive Surgery, General Surgery Center, National Children's Hospital: Gastric torsion is a condition of abnormal rotation of a part of the stomach around the remaining part of it, from 180 degrees to 360 degrees.

Gastric volvulus is divided into two main types: visceral volvulus and mesenteric volvulus.

This is a very rare disease in children, especially children over 12 months old and not accompanied by other diseases. If the disease is not diagnosed and intervened promptly, it can cause gastric anemia, leading to perforation, necrosis of the entire stomach, and even death.

The cause of gastric torsion is often due to abnormalities in the ligaments that fix the stomach, as in the case of baby QA, or can occur in children with diaphragmatic hernia or hiatal hernia.

The disease is dangerous. A 3-year-old child has a gastric ulcer. Figure 2 — Gastric torsion image

Common symptoms of the disease in older children are nausea, vomiting; abdominal distension, epigastric pain; and gastric tube obstruction.

In infants, regurgitation and vomiting are common symptoms, which may include yellow or clear fluid depending on the location of the obstruction, and sometimes blood. In cases of diaphragmatic hernia, the stomach in the chest often has symptoms of respiratory failure and rapid breathing.

Diagnosing gastric torsion is quite difficult because the symptoms of the disease are similar to abdominal pain caused by many other common causes.

Gastric torsion is often difficult to accurately determine before surgery. To do this requires a combination of meticulous clinical examination and appropriate paraclinical tests such as ultrasound, X-ray, abdominal CT scan, etc.

Doctors recommend: In addition to common causes of intestinal obstruction and gastric dilation in children, less common causes such as gastric torsion should also be considered.

For parents and caregivers, when children suddenly vomit a lot and have abdominal pain, they should take them to a specialized hospital for timely diagnosis and treatment to avoid possible dangerous complications.

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