Lesions of the stomach
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The clinical picture in scenario 4 is suggestive of gastric volvulus. A distended stomach in an abnormal position should raise suspicion of gastric volvulus. A single radiograph may be diagnostic. Acute mesenteroaxial volvulus is seen on a plain radiograph by identifying the pylorus/antrum being higher than the gastrooesophageal junction. In organoaxial volvulus the greater curvature is seen to lie higher than the lesser curvature. Radiographic examination with an upper GI contrast study confirms the diagnosis and often identifies underlying associated congenital anomalies or defects. The radiographic features of acute volvulus include (1) localised massive distension of the upper abdomen, (2) higher greater curvature of the stomach, (3) greater curvature crossing the stomach, (4) fixation of the loop regardless of the position of the patient, (5) delimitation of ingested contrast at the tapered extremity of the oesophagus (bird’s beak), (6) possible evidence of a hiatal sacculation or other diaphragmatic herniation and (7) deviation of the position of the spleen.
Gastrointestinal and Genitourinary Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
Gastric volvulus is defined as an abnormal rotation of the stomach along its mesentery, which can result in a closed loop obstruction. Cases can be divided broadly into three types: organoaxial, mesenteroaxial and mixed. Organoaxial is more common, comprising over two thirds of cases (Peterson et al., 2009), and occurs when the stomach rotates along its long axis (Figures 2.41a, b). The greater curvature is displaced superiorly while the lesser curvature moves caudally. This subtype of volvulae can be associated with traumatic diaphragmatic and para-oesophageal hernia. Mesenteroaxial is less common and occurs when the stomach rotates around its short axis, resulting in displacement of the gastric antrum to a level above the gastro-oesophageal junction (Figures 2.42a, b). All subtypes can be asymptomatic and chronic, or present acutely with symptoms of pain and obstruction. Symptoms and signs of acutely symptomatic cases are described by Borchardt’s triad: epigastric pain, intractable retching and inability to pass an NG tube. The greatest concern in cases of acute obstruction is strangulation of the twisted segment, which should be especially suspected in the presence of an elevated serum lactate level. Urgent diagnosis is vital in order to facilitate potential surgical intervention. It is important to note that chronic cases are often diagnosed incidentally on CT and fluoroscopy studies performed for other indications, and the diagnosis must always be correlated with patient symptoms.
Abnormal Anatomy of the Stomach and Duodenum
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Gastric volvulus is an abnormal rotation of one part of the stomach around another, with obstruction of the lumen and compression of vessels that can result in tissue ischemia and necrosis. Defective fixation of the stomach can lead to three different types of abnormal rotation: organoaxial, mesenteroaxial, or a combination of the two. Most of the congenital gastric volvuli are seen in infants with diaphragmatic defects (congenital diaphragmatic hernia) and absence or excessive laxity of gastric ligaments. Clinically, 70% of infants present with a classic Borchardt triad: pain, retching (with little vomiting), and inability to pass a nasogastric tube. Radiographic studies with plain radiographs and UGI barium series will outline an abnormal contour and position of the stomach as well as abnormal position of pylorus in relation to gastroesophageal junction. Timely recognition is essential to facilitate urgent surgical intervention with reduction of the volvulus and gastric fixation.
A rare cause of severe epigastric pain, emesis and increased lipase
Published in Acta Chirurgica Belgica, 2018
Daan Van Olmen, Francis Somville, Gerry Van der Mieren
Two main classifications of gastric volvulus are described [1–3]. First of all, gastric volvulus can be classified as primary or secondary, based upon its etiology. Primary or idiopathic gastric volvulus occurs when abnormalities of the anchoring ligaments of the stomach are present. Elongation or rupture of the gastric (gastrocolic, gastrohepatic, gastrosplenic and gastrophrenic) ligaments caused by neoplasia, trauma or kyphoscoliosis are possible causes of primary gastric volvulus. Failure of this anchoring mechanisms can cause rotation of the stomach. In case of secondary gastric volvulus, the abnormal rotation is due to anatomical defects (except for ligament failure), such as paraesophageal hernia, traumatic diaphragm defect, tumor or phrenic nerve paralysis [1]. Paraesophageal hernia is the leading cause of this secondary gastric volvulus in approximately 60% of the cases [2].
Sigmoid volvulus: a rare but unique complication of enteric fever
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Muhammad Sohaib Asghar, Abubakar Tauseef, Hiba Shariq, Maryam Zafar, Rumael Jawed, Uzma Rasheed, Mustafa Dawood, Haris Alvi, Saad Aslam, Marium Tauseef
Patients of Sigmoid Volvulus usually present with constipation, diarrhea, vomiting, abdominal distention, tense and tender abdomen, bright red blood in the stool, and sluggish gut sounds. On digital rectal examination, the rectum may be empty or may contain fresh blood in it [8]. It is an acute surgical emergency because on a very narrow window period it makes complications more likely which may range from gut ischemia, gangrenous bowel segment, peritonitis, shock, sepsis, and even perforation [9]. Making a diagnosis of sigmoid volvulus depends on clinical signs as well as imaging modalities. X-Ray abdomen may show dilated sigmoid colon, air-fluid levels or coffee bean sign [10]. Barium enema shows tapering of bowel lumen as a bird’s beak sign, but it is generally not carried out in patients with the risk of impending gut ischemia or perforation. Computed tomographic scan (C.T scan) is the latest modalities of interest, may show horseshoe sign, omega sign, coffee bean sign, whirl pattern, steel pan sign, and inverted V or U sign [10–12].
Antibiotic-driven intestinal dysbiosis in pediatric short bowel syndrome is associated with persistently altered microbiome functions and gut-derived bloodstream infections
Published in Gut Microbes, 2021
Robert Thänert, Anna Thänert, Jocelyn Ou, Adam Bajinting, Carey-Ann D. Burnham, Holly J. Engelstad, Maria E. Tecos, I. Malick Ndao, Carla Hall-Moore, Colleen Rouggly-Nickless, Mike A. Carl, Deborah C. Rubin, Nicholas O. Davidson, Phillip I. Tarr, Barbara B. Warner, Gautam Dantas, Brad W. Warner
Surgical removal of the intestine is often necessary to treat gastrointestinal disorders such as necrotizing enterocolitis, volvulus, gastroschisis, and intestinal atresia.1 Extensive intestinal loss may result in a form of intestinal failure known as short bowel syndrome (SBS).2,3 In SBS, reduced intestinal surface area is inadequate for normal nutrients, electrolytes, and fluid absorption. As a result, patients require sustained parenteral nutrition (PN) to support growth and development.4 While lifesaving, prolonged PN is associated with SBS-related morbidity and mortality, most notably bloodstream infections (BSIs)1,5 and PN-associated liver disease (PNALD).2,6 Further, SBS patients frequently develop increased bowel caliber and reduced peristalsis resulting in small bowel bacterial overgrowth (SBBO).7 Increased gut-derived bacterial burden in the context of SBBO is implicated in contributing to PNALD.8 Retrospective studies of BSIs in SBS patients have further implicated common constituents of the intestinal flora.9 As a result, SBS patients are frequently exposed to multiple courses of oral and intravenous antibiotics to prevent and treat SBBO, PNALD, and BSI.
Related Knowledge Centers
- Abdominal Pain
- Bloating
- Constipation
- Fever
- Gastrointestinal Tract
- Mesentery
- Blood
- Bowel Obstruction
- Blood In Stool
- Intestinal Ischemia