SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Organo-Axial Gastric Volvulus in an 11-Year-Old Patient

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An 11-year-old girl with a complex history of polytrauma from a motor vehicle crash, including T4 paraplegia, neurogenic bowel/bladder, prior bowel resection, and spinal fusion, presented to the emergency department with intractable vomiting and left shoulder pain. She was thin but hemodynamically stable and had a benign abdominal exam, despite ongoing emesis.<br /><br />Initial imaging showed a large stool burden on abdominal x-ray, and chest x-ray was interpreted as an elevated left hemidiaphragm with a gastric bubble in the left lung field. She was treated for fecal impaction with nasogastric cleanout, but continued to be unable to tolerate oral intake after the cleanout. Because of persistent vomiting and recent weight loss, concern arose for superior mesenteric artery syndrome, prompting an upper GI series.<br /><br />The upper GI study revealed organo-axial gastric volvulus, explaining her symptoms. She underwent surgery, where the stomach was found elevated and protruding through a left diaphragmatic hernia. The volvulus was reduced, the diaphragmatic defect repaired, and gastropexy performed. A gastrostomy tube was placed to help anchor the stomach and support nutrition.<br /><br />This case highlights that organo-axial gastric volvulus, though rare in children, should be considered in patients with chronic constipation, recurrent vomiting, left shoulder pain, prior trauma, and multiple abdominal surgeries. Chest or abdominal x-rays may provide early clues, such as an elevated hemidiaphragm or abnormal gastric bubble position, but definitive diagnosis is made with upper GI contrast studies or CT. Surgical repair is the definitive treatment, especially when diaphragmatic abnormalities are present.

Asset Subtitle

Cristina M. Del Valle Avila

Meta Tag

Author List Camille Carre, Cristina M. Del Valle Avila

Category Clinical Vignettes

Concept Organo-axial Gastric Volvulus

Concept Gastric Volvulus

Concept Intractable Vomiting

Concept Upper GI Series

Concept Cross-Sectional Abdominal Imaging

Distinguished Non-Finalist

Presenter Organization University of South Florida Department of Pediatrics

Presenting Author Cristina M. Del Valle Avila

Track Pediatric

Keywords

organo-axial gastric volvulus

pediatric vomiting

left diaphragmatic hernia

superior mesenteric artery syndrome

fecal impaction

neurogenic bowel

polytrauma

upper GI series

gastropexy

gastrostomy tube

Organo-axial Gastric Volvulus

Gastric Volvulus

Intractable Vomiting

Upper GI Series

Cross-Sectional Abdominal Imaging