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UGI Series Is Study of Choice for Gastric Volvulus

February 17, 2008
Written by: , Filed in: Gastrointestinal Imaging, Pediatric Radiology
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The objective of a recent study was to present the spectrum of imaging findings for gastric volvulus in children, and to correlate the type of gastric volvulus with clinical and imaging characteristics.
The study has concluded that radiographic findings of spherical gastric dilatation, paucity of distal gas, and diaphragmatic elevation are suggestive of acute gastric volvulus in children.

Methodology
Children presenting with gastric volvulus during a 5-year study interval were identified in the medical records. The imaging studies and clinical records were retrospectively reviewed. Images included abdominal radiographs, upper gastrointestinal (UGI) series, and CT. These were reviewed by three staff pediatric radiologists.

On UGI, four types of gastric volvulus were identified. Organoaxial (OA) volvulus was diagnosed when the greater curvature of the stomach was superior to the lesser curvature, with the pylorus pointed inferiorly.

Partial OA volvulus was diagnosed when only a portion of the stomach demonstrated features of OA volvulus.

Mesenteroaxial (MA) volvulus was diagnosed when the pylorus was displaced superiorly and toward the left of the gastroesophageal junction.

Mixed-type volvulus was diagnosed when OA and MA were present. Patients were classified into three groups based on presentation: acute fulminant, chronic intermittent, and neonatal groups.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists

Results of the Study
10 children were included in the study. Acute fulminant presentation was seen in four children (MA volvulus diagnosed on UGI, n=3; mixed-type volvulus diagnosed on UGI, n=1). Four children had a chronic intermittent clinical presentation (MA volvulus, n=1; partial or complete OA volvulus, n=3).

Neonatal presentation corresponded to OA volvulus without gastric outlet obstruction and was considered to be an incidental finding. UGI was diagnostic in nine patients and determined the type of volvulus in each. The other patient presented with an acute fulminant clinical picture, and diagnosis was made on an incidental CT.

Conclusions
In these 10 children, the rare entity of gastric volvulus was successfully diagnosed and characterized 90% of the time. Abdominal radiographs demonstrating a large spherical bubble in the upper abdomen with a paucity of distal bowel gas in a patient with acute fulminant symptoms should alert the physician to a possible gastric volvulus.

Reviewer’s Comments
Although the sample size was small, the patients who presented with the acute fulminant clinical picture had a pure MA volvulus 75% of the time and at least a component of MA volvulus the rest of the time. Recognizing the UGI findings of this particular subset of gastric volvulus is the radiologist’s responsibility in preventing further morbidity or mortality.

Author: Basil Hubbi, MD

Reference:

Oh SK, Han BK, et al. Gastric Volvulus in Children: The Twists and Turns of an Unusual Entity. Pediatr Radiol; 2008; 38 (March): 297-304

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists
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