Acute gastric volvulus combined with pneumatosis coli rupture misdiagnosed as gastric volvulus with perforation:A case report

BACKGROUND Acute gastric volvulus represents a rare form of surgical acute abdomen,which makes it difficult to establish an early diagnosis.As the disease progresses,it can lead to gastric ischemia,necrosis,and other serious complications.CASE SUMMARY This paper reports a 67-year-old female patient with a history of abdominal distension and retching for 1 day.After admission,a prompt and thorough exami-nation was performed to confirm the diagnosis of acute gastric volvulus.Notably,the patient had free air in the abdominal cavity.The first consideration was gastric volvulus with gastric perforation,but the patient had no complaints,such as abdominal pain or signs of peritoneal irritation in the abdomen,and imaging examination revealed no abdominal pelvic effusion.Following endoscopic reduc-tion,the abdominal organs,such as the stomach and spleen,returned to their normal anatomical positions,and the free intraperitoneal air disappeared,su-ggesting a rare case of acute gastric torsion.The source of free air within the abdominal cavity warrants careful consideration and discussion.Combined with the findings from computed tomography,these findings are hypothesized to be associated with the rupture of colonic air cysts.CONCLUSION Patients with gastric torsion combined with free gas in the abdominal cavity should consider nongastrointestinal perforation factors to avoid misdiagnosis.

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 presenting as an acute coronary syndrome with long-lasting electrocardiographic changes

A sixty-one-year-old male,with a medical history of coronary heart disease and myocardial bridge (not confirmed by cardiac catheterization) in the past three years and a 1-h history of sudden onset nausea,retching,diaphoresis,epigastric discomfort without any chest pain.The electrocardiogram revealed ST elevation myocardial infarction (STEMI) changes (Figure 1A).Urgent cardiac catheterization revealed mild myocardial bridge in the middle of the left anterior descending (LAD)(10% systolic compression) and normal left ventricular function without regional wall motion abnormalities.Three high-sensitivity cardiac troponin I (HSTNT) titers done at 4,8 and 20 h from the onset of symptoms were HSTNT =10.5 pg/mL,10.9 pg/mL,25.4 pg/mL (less than 26.2) with CK-MB = 3 pg/mL,18 pg/mL,13 pg/mL (< 25) and the myoglobin levels were = 34.8 pg/mL,39.6 pg/mL,44.5 pg/mL (< 140.1),respectively.

Interesting and unusual cases of chronic abdominal pain-intermittent gastric volvulus

Objective: Intermittent gastric volvulus is a rare disease that requires high index of suspicion for diagnosis and treatment. The incidence and prevalence is unknown, may be due to under reporting or under diagnosis. Gastric volvulus may be transient producing few symptoms. The Borchardt’s Triad may be present only during an acute presentation. Common symptoms may mislead to diagnose a nonsurgical disease if an evaluation is not done, keeping in mind a possibility of gastric volvulus, even if a UGI scopy is normal. Cases may be submerged in the community being undiagnosed. Case Series: CASE 1: 21 yrs old male with intermittent abdominal pain for 1(1/2) yrs with marfanoid habitus, MVP and a normal UGI scopy. BMS revealed an Organo-Axial Volvulus and ligament laxity per-operatively. CASE 2: 65 yrs old diabetic female with vomiting and abdominal pain for 3 months and left sided pneumonitis. UGI scopy showed twisted gastric folds immediately below OGJ and inability to visualise antrum. BMS revealed mixed volvulus with paraesophageal herniation of distal stomach. Per-operatively there was laxity of ligaments with omental content alone within the diaphragmatic rent. Posterior retrocolic sub-mucosal gastrojejunostomy(pexy) was done for all cases. Conclusion: Gastric volvulus should be thought of in a case of chronic intermittent abdominal pain with normal baseline evaluation. A Chest X-ray and BMS should be done, at the time of symptoms.

Organoaxial Gastric Volvulus—Chronic Hematoma and a Gastric Twist

A 70-year-old male presented with gastric volvulus secondary to a hematoma that caused an organoaxial rotation. Contrast-enhanced CT was contributory to the diagnosis. The patient underwent laparotomy with gastrojejunostomy and jejunojejunostomy. We present our findings and review the literature of this uncommon pathology. A written informed consent was obtained from the patient for publication of this case.

Gastric Volvulus Complicates the Hepatectomy for Living Donor Liver Transplantation

Donor safety is the major concern in living donor liver transplantation (LDLT), and a constant aware of postoperative morbidity should be emphasized. Between March 2002 and May 2011 we performed 435 liver transplantations at an our center, one hundred forty eight with living donors. Among them left lobectomy or left lateral resections were conducted in 68 cases. Symptoms of gastric obstruction were recognized in 3 out of 68 patients that underwent left lateral resection (4.4%). The patients were readmitted because of severe symptoms of vomiting and abdominal pain. An upper endoscopy was performed and revealed pyloroantral obstruction due to gastric volvulus (GV). Endoscopic therapy correction was successfully performed in all patients. Reviewing the literature, one article has reported GV in 13 out of 115 donors (11.3%), all patients were submitted to a left resection. The mechanisms underlying this complication, in LDLT scenario, have not been fully elucidated. Nevertheless, clinicians should be aware of this possible association, which could make the diagnosis of GV more likely if a living donor comes back with typical symptoms.

Management and outcomes of gastric volvulus in children: a systematic review

Background Gastric volvulus (GV) in children is a rare condition.This study reviewed management and outcomes of GV in the pediatric population.Methods MEDLINE/PubMed,Embase,and Google Scholar databases were searched for studies in English regarding GV in patients < 18 years old between 2008 and 2017,selected by two reviewers.Results were presented as percentages and medians.Fisher's exact test was used to evaluate categorical variables,and Bonferroni correction was applied for multiple comparisons.Results Ninety-seven papers with 125 patients were included.The median age was 24 months,with slightly female preponderance.Vomiting was the most common symptom and acute presentation occurred in the majority of cases.History of previous surgery/abdominal trauma was described in 12 and 3 children,respectively.Radiology was diagnostic for GV in most cases.The initial management was surgical in the majority of cases,with most of them including gastropexy,gastrostomy,or gastric resection.Mesenteroaxial GV was associated with acute presentation (P =0.004) and the latter with ischemia (P < 0.01).Complications occurred in 23 (18.9%) children,esophageal stenosis being the most common.There were eight (6.4%) deaths,and only one recurrence 6 months after endoscopic management.The median follow-up period was 12 months.The inclusion of only case reports/case series,the incomplete reporting from papers,and the short followup were limitations of the study.Conclusions GV occurs at a median age of 24 months and requires high suspicion and prompt management,as mortality is considerable.The preferred surgical approach for GV includes variations of gastropexy.Esophageal stenosis is the most common morbidity post-GV management.

Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.

1例犬胃扭转和胃扩张的诊疗报告

胃扭转和胃扩张的病理原因非常复杂,尚未完全解释清楚。临床中,犬胃扭转和胃扩张属于急诊病例,严重时可危及生命,需要立刻诊断并尽快采取手术。犬胃扭转和胃扩张特征为胃内气体迅速积聚,胃内部压力升高并发生不同程度的胃体移位,患犬典型症状表现为呕吐、腹痛及明显的胃内胀气。文章主要讲述一例犬胃扭转和胃扩张病例的诊断和治疗。患犬经腹部X射线检查确诊后,通过手术治疗、输液治疗、适当的营养管理和其他必要的对症治疗后,恢复良好,顺利出院。

Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on postoperative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.

胃扭转

胃扭转是一种少见病,发病高峰年龄为40~60岁和小于1岁人群,多与膈肌异常和胃韧带缺陷相关,临床分为急性和慢性胃扭转,急性胃扭转可危及生命,根据Borchardt三联征症状和X线钡餐检查可做出诊断,本文对胃扭转的病因、分类、诊断及治疗研究进展进行综述,以期提高对胃扭转的诊治水平。

胃扭转的诊断和治疗:附30例报告

目的 探讨胃扭转的发病机制、诊断及治疗。方法 回顾性分析 3 0例胃扭转的临床资料。结果 术前确诊 1 7例 ( 5 6. 7% ),手术中确诊 1 3例 ( 4 3. 3% )。诊断为纵轴型 2 1例 ( 7 0. 0% ),横轴型 8例 ( 2 6. 7% ),混合轴型 1例 ( 3. 3% )。 3例行内镜下复位, 2 7例接受手术治疗。 3 0例均康复出院,全组病例均随访 5年,内镜下复位后复发 1例,余病例无复发。结论 胃扭转主要由胃周支持韧带松弛引起,发病由多因素共同作用所致。诊断依据临床表现和影像学检查综合分析或手术探查,治疗首选手术。

中西医结合治疗小婴儿肺炎合并胃扭转和胃食管反流的检测特点及治疗探讨

目的观察常规抗炎、抗反流与"和中扶正推拿疗法"整复胃扭转的治疗方案对肺炎合并胃扭转、胃食管反流(GER)患儿预后及气道酸碱度的影响,为小婴儿肺炎合并胃扭转、GER的临床诊断及治疗提供依据.方法选择2013年1月至2015年12月武汉儿童医院中西医结合科住院的60例经胸部影像学和上消化道碘水造影诊断为肺炎合并胃扭转和GER 1~6个月龄患儿,按检测方法的不同分为观察1组(30例)和观察2组(30例),观察1组采用24 h上消化道pH值动态监测,观察2组采用24 h食管多通道腔内阻抗联合pH值监测.另设经上消化道碘水造影诊断为胃扭转和GER而无肺炎的对照1组(30例)以及经上消化碘水造影诊断为单纯胃扭转的对照2组(30例).肺炎的治疗按照儿童社区获得性肺炎管理指南执行;胃扭转和GER治疗采用体位疗法、饮食疗法、促动力药以及和中扶正推拿疗法〔由5穴组成,取穴及手法依次为:横纹推向板门(直推法)300次、分腹阴阳(拇指分推法)200次、摩腹(顺时针)100次、揉天枢穴100次、揉按双侧足三里各100次.每日推拿1次,每次(15±2)min,共7 d〕.记录观察1组上消化道pH值监测结果;比较观察组2组与对照组间食管多通道腔内阻抗联合pH值监测结果.连续治疗7 d后,观察两个观察组患儿肺炎和胃扭转临床疗效、住院时间、转归和治疗前后痰液pH值的变化.结果两个观察组60例患儿胃扭转主要以器官轴型为主(55例,占91.67%),60%以上患儿痰液pH值<7.0.观察1组上消化道pH值动态监测显示酸性反流26例(占86.67%);GER阴性4例(占13.33%),GER阴性患儿pH值<4的反流比例较中度酸性者明显降低〔3.35%(0.77%~8.08%)比26.23%(15.19%~42.87%),P<0.05〕,长反流(>5 min)次数较轻度酸性者明显减少〔次:2(0~5)比7(2~15),P<0.05〕,最长反流时间较轻、中度酸性者明显缩短〔min:5.9(2.5~10.0)比19.2(5.9~51.0)、41.6(16.9~121.0),均P<0.05〕.观察2组食管多通道腔内阻抗联合pH值监测显示病理性反流30例,主要为弱酸反流(占90%),其中近端反流次数占总反流事件的46.07%.观察2组酸反流次数和近端反流次数均较对照1组和对照2组明显增加〔分别为1305(37.72%)比795(25.69%)、136(18.89%)和1594(46.07%)比687(22.20%)、154(21.39%),均P<0.05〕;两个观察组总有效率及住院时间比较差异均无统计学意义〔总有效率:100%比100%,住院时间(d):7.58±1.09比7.67±1.12,均P>0.05〕.结论在小婴儿肺炎合并胃扭转和GER诊断中,初次选择上消化道碘水造影加胸部影像学检查,能及时明确肺炎和严重程度以及是否合并胃扭转及其分型,是否同时存在GER.24 h上消化道pH值动态监测对酸性反流的判断与24 h食管多通道腔内阻抗联合pH值监测对GER具有一致性,后者还能识别非酸性反流,对反流的诊断更精准.胃扭转合并GER及肺炎患儿的近端反流比值均较高,容易引起呛咳和误吸,临床应重视其早期诊断,及时干预.痰液pH值测定能反映气道内酸碱情况,其操作方便简单,可用于病情实时评估,吸痰还能帮助治疗.本课题组拟定的治疗方案能提高疗效,改善气道酸性环境,有利于改善预后.

早期干预胃扭转对巨细胞感染淤胆性肝病婴儿发生肺炎及预后影响的前瞻性随机对照研究

目的：探讨早期采用中、西药及手法按摩对巨细胞病毒（CMV）感染淤胆性肝病（ICH）婴儿合并胃扭转病程中发生肺炎及肺炎严重程度和预后的影响。方法采用前瞻性随机对照研究方法，选择武汉市儿童医院中西医结合科住院的1～6个月小婴儿120例，按随机数字表法分为治疗组与对照组，每组60例。两组均给予中药利胆合剂（组成：茵陈蒿30 g，连翘30 g，黄连5 g，熟大黄5 g，赤芍30 g，桂枝5 g，枳壳10 g，白术10 g，五味子10 g，穿山甲3 g，甘草5 g）口服或灌肠，更昔洛韦静脉滴注等综合治疗；对照组在综合治疗基础上胃扭转采用体位疗法、饮食疗法、给予促动力药吗丁啉（多潘立酮）；治疗组在综合治疗基础上对胃扭转采用手法按摩复位治疗。两组肺炎按照小儿肺炎、毛细支气管炎、重症肺炎诊疗常规、儿童社区获得性肺炎管理指南治疗。观察两组治疗前后病程中发生肺炎总例数和肺炎严重程度，以及ICH、胃扭转、婴儿肺炎的临床疗效、临床体征、生化指标及住院时间的差异。结果治疗组治疗后ICH、胃扭转、婴儿肺炎的治愈率和总有效率均较对照组升高〔ICH治愈率：83.05%（49/59）比71.93%（41/57），总有效率：96.61%（57/59）比91.23%（52/57）；胃扭转治愈率：72.88%（43/59）比51.79%（29/56），总有效率：96.61%（57/59）比78.57%（44/56）；婴儿肺炎治愈率：81.08%（30/37）比67.44%（29/43），总有效率：100%（37/37）比100%（43/43），P＜0.05或P＜0.01〕。治疗组治疗过程中肺炎发生总例数和重症肺炎发生率均较对照组明显减少〔肺炎总例数：12例比21例，重症肺炎发生率：16.67%（2/12）比42.86%（9/21），P＜0.05或P＜0.01〕。两组治疗后肝脾肿大程度、总胆红素（TBil）、直接胆红素（DBil）、总胆汁酸（TBA）、丙氨酸转氨酶（ALT）均较治疗前明显降低，且以治疗组降低更显著（P＜0.05或P＜0.01），治疗组住院时间（d）较对照组缩短（21.32±3.26比27.38±6.09，P＜0.05）。结论对CMV感染ICH婴儿合并胃扭转采用中西医疗法早期干预能明显降低病程中发生肺炎的概率和严重程度，有利于CMV感染ICH患儿的治疗和预后。

支气管肺炎合并胃扭转临床特征分析

目的分析支气管肺炎合并胃扭转的临床特征。方法选取2009年1月-2012年11月住院的明确诊断婴儿支气管肺炎、上消化道钡餐(GI)明确胃扭转132例,同时选取同期住院婴儿支气管肺炎、GI为阴性48例患儿为对照组。分析两组患儿的临床、实验室检查资料和影像学的表现。结果 (1)132例婴儿支气管肺炎合并胃扭转与对照组相比,多发生于3月(2.64±1.70月),住院前病程较长(10天),住院时间延长,临床表现多样,奶后呛咳达23.3%,器官轴型占100%;(2)胃扭转致胃食管返流是触发因素,给予正规体位治疗可快速缓解支气管肺炎病情,无手术病例。结论婴儿支气管肺炎合并胃扭转多发生于3月大婴儿,是婴儿肺炎病程迁延难治的原因之一,奶后呛咳是其特征表现,体位疗法可取得满意疗效。

90例类百日咳临床特征分析

目的:了解儿童类百日咳的临床特征和转归。方法:收集2012年6月-2013年6月在郑州市儿童医院治疗的90例类百日咳患儿的病例资料。结果:6个月以下婴儿占63例(70%),50例患儿行上消化道造影检查,其中43例(86%)合并有胃扭转及胃食道返流等。所有患儿均给予大环内酯类抗生素治疗,87例患儿缓解出院,3例患儿好转自动出院。结论:类百日咳多为病毒与细菌混合感染所致,多见于6个月以下婴儿,对于治疗效果不理想的患儿,应重视合并胃扭转及胃食道返流的可能性,注意合理喂养方式及体位。

胃扭转的X线诊断和手法整复

目的:分析胃扭转的X线表现,应用数字化胃肠X线机提高胃扭转的类型和扭转方向的诊断准确率和手法整复率。方法:分析近年来检查发现的31例胃扭转的X线表现,其中:器官轴型24例,经手法整复21例。网膜轴型7例,经手法整复2例。结果:器官轴型胃扭转多见,手法整复成功率高。网膜轴型胃扭转较少见,手法整复成功率较低。结论:应用数字化胃肠X线机提高胃扭转的类型和方向的诊断准确率,对提高手法整复率有重要意义。

慢性胃扭转的病因和治疗探讨

目的 探讨慢性胃扭转的病因和治疗效果,以便选择更适当的治疗方法。方法 回顾性分析我院30年来收治的慢性胃扭转27例,分析其临床表现、类型、合并症及其发病诱因,评价各种治疗方法的效果。结果 全组慢性胃扭转27例。其中器官轴扭转21例,系膜轴扭转2例,混合型扭转4例。存在明显诱因的有19例(70.4％)。手术治疗治愈13例,单纯非手术治疗治愈5例,症状好转出院7例,未愈2例。结论 慢性胃扭转是胃扭转的主要类型,常无特异临床表现,常存在诱因,钡餐造影是诊断本病的主要手段,外科手术是治愈本病的主要措施。

慢性胃扭转38例分析

分析38例慢性胃扭转。8例网膜轴型中有1例仅表现胃窦和十二指肠球部扭转到胃体左侧,十二指肠球部后段与胃体垂直相交,但胃窦部大弯仍在下,小弯仍在上,我们称为非称典型网膜轴型。1例在开始时显示为混合轴型,以后在造影过程中转变为网膜轴型。器官轴型中有1例由右侧膈疝引起。此例也在造影过程中自行复位,应进一步检查找出潜在原发病,必要时手术治疗。

慢性胃扭转的X线诊断

目的 :评价钡餐造影诊断慢性胃扭转的价值。方法 :回顾性分析 6 9例慢性胃扭转的 X线征象。结果 :慢性胃扭转必须进行钡餐造影才能确诊。器官轴型显示胃大弯上翻位于胃小弯之上、食管腹段延长并开口于胃的下方、食管黏膜及胃黏膜交错、幽门高于十二指肠球部、双胃泡和双液平面 ;网膜轴型显示胃窦部翻向左上方、胃黏膜呈十字交叉、斜位观胃窦与胃体形成钡环、食管腹段不延长、双液平。结论