A two year old male child, presented with complaints of intolerance to solid and thick fluids since birth, with non bilious profuse vomiting. There was no accompanying pain, distension of abdomen. General physical and systematic examinations were essentially normal except for the findings of a coronal hypospadias and anaemia. (Hb - 7 gms)

Plain X-rays of the chest and abdomen were normal. Barium meal confirmed the diagnosis of gastric volvulus. An ultrasound of the abdomen done to rule out associated anatomical defects was normal.

Laparoscopic surgery was performed with open (Hassan’s) technique using CO2 insufflation, pressure 8-10 mm of Hg and using Zero degree telescope. Stomach showed proximal hypertrophy. The antral volvulus part was reflected back to normal position. Three point fixation of the greater curvature of stomach to anterior abdominal wall was done with 2/0 prolene. Stomach could be inflated at the end of procedure with no evidence of volvulus. The child was started on feeds the next day with no difficulty.

Berti first described gastric volvulus in 1866. To date it remains a rare clinical entity. Borchardt described the classic triad of severe to epigastric pain, retching without vomiting and inability to pass a nasogastric tube, in 1904, Muller et al.1 Reported that in children mesenteroaxial volvulus is the most common type. Georgapulo P et al report that acute gastric volvulus presents with signs of vomiting, pain, abdominal distension. Chronic gastric volvulus usually present with intermittent vomiting, pain, gastro oesophageal reflux and may be associated with hiatus hernia and diaphragmatic defects.

Fig.1	Fig.2

Radiology often confirms the diagnosis. De Lorimer and Penn specified the features of acute gastric volvulus - delineation of the ingested barium at the tapered extremity of the oesophagus, the so called the bird’s beak.7 While in chronic volvulus, in mesenteroxial, the stomach is spherical supine plain film, with two fluid levels on the erect film, one in the fundus (lower) and one in the antrum (upper). There may be paucity of gas in the remainder of the gastrointestinal tract.

Treatment of gastric volvulus has changed over the years. Conservative treatment in the form of prokinetics and antireflux position may be used for the chronic idiopathic volvulus.9

Surgical Treatment : The various options available are - simple gastropexy (open) diaphragmatic hernia repair and division of bands. Tanner’s operation i.e. Gastropexy with division of gastrocolic omentum partial gastrectomy for acute gastric volvulus if there is gastric necrosis. Oplozer’s operation Gastrojejunostomy with fundoantral gastro gastrostomy with repair of eventration of diaphragm. The other options are Stamm’s gastrostomy preferred where there is anatomical defect. Laparoscopic gastropexy with repair of anatomical defects, PEG (Percutaneous endoscopic gastrostomy).

Fig.3