THE PEDIATRIC DIAPHRAGM IN ACUTE GASTRIC VOLVULUS

Acute gastric volvulus occurred in nine infants and one older child du ring the past 19 years; all patients had an associated left diaphragma tic anomaly. There were seven examples of eventration of the diaphragm , two of giant hiatal hernia and one Bochdalek hernia. Nine of the ten patients presented with vomiting and one with acute respiratory distr ess. The gastric volvulus was mesenteroaxial in eight patients and org anoaxial in two. Operative treatment consisted of repair of the diaphr agmatic anomaly and gastric fixation in eight patients. Gastric fixati on alone was performed in one patient. A single patient died preoperat ively and had gastric necrosis at postmortem examination. Of the nine patients treated operatively, all remain alive and well without recurr ence. Acute gastric volvulus should be considered in any infant presen ting with unexplained vomiting in association with a left diaphragm an omaly, and once diagnosed, immediate operation is mandatory.