Conservative management of chronic gastric volvulus:44 cases over 5 years

AIM:To investigate clinical outcomes of patients with chronic gastric volvulus(GV)who were managed conservatively over a 5-year period.METHODS:A total of 44 consecutive patients with chronic GV,as diagnosed by barium study between October 2002 and July 2008 were investigated.All of these patients received conservative management initially without anatomical correction.Their clinical manifestations,diagnostic work-ups,and clinical outcomes were analyzed.We sought to identify independent risk factors for poor outcome by using the Cox proportional hazards model.RESULTS:The enrolled patients were predominantly male(n=37,84%)and of advanced age(median: 71 years old,interquartile range:57.5-78 years).Abdominal pain and fullness were the most common presentations.During the follow-up period(median:16 mo,up to 69 mo),there was no severe complication,but symptomatic recurrence was noted in 28 patients(64%).Only one patient turned to elective surgery for frequent symptoms.Peritoneal adhesion was the only independent risk factor associated with recurrence(hazard ratio:2.58,95%CI:1.08-6.13,P=0.033).CONCLUSION:Symptomatic recurrence of chronic GV is very common although serious complications infrequently occur with conservative management.Peritoneal adhesion is independently associated with recurrence.

GASTRIC VOLVULUS: A Case Report and Literature Review

Background: Gastric volvulus is a rare surgical emergency that causes an upper digestive obstruction due to a rotation of the stomach greater than 180°. Observation: We report the case of a 2-year-old patient referred from a health care facility for incoercible vomiting. On admission, the clinical examination revealed that the condition started about 1 month back with poor general and nutritional condition. Pyloric stenosis was suspected but this hypothesis was rejected based on abdominal ultrasound. Further investigations were done with an abdominal X-ray and an upper gastrointestinal barium study which led to the conclusion of an organo-axial gastric volvulus. The patient died in the course of treatment. Conclusion: Gastric volvulus is an often-misunderstood condition. Upper gastrointestinal barium study remains the gold standard of diagnosis. Its management is surgical.

Imaging of the small bowel:Crohn's disease in paediatric patients

In more than 20% of all patients, the Crohn's diseasepresents before the age of 18 years. The diagnosisand management of Crohn's disease in children haschanged dramatically over the last decade, mainly dueto increased awareness, availability of newer diagnosticmodalities such as magnetic resonance imaging(MRI)and newer, more powerful treatments such as biolog-ics. Imaging of the small bowel is needed for diagno-sis, management, follow-up and also evaluation of thedisease in terms of location, extent, activity and com-plications. We review all the methods(barium exami-nations, ultrasonography, computed tomography, MR,and computed tomography- positron emission tomog-raphy) commonly used for imaging the small bowel inpaediatric patients with Crohn's disease analyzing theadvantages and disadvantages of each modality, withparticular emphasis on MR imaging.