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A 5 day old baby boy with persistent bilious vomiting was referred to our neonatal unit. He passed normal stools and his abdomen was soft and non-tender. A plain radiograph of the chest and abdomen (fig 1) showed that the dome of the left diaphragm was elevated, suggesting eventration. The oesophagus was dilated, a gastric air shadow could be seen in the left chest, and there was no gas shadow in the abdomen. An upper gastrointestinal contrast study (fig 2) revealed left sided diaphragmatic eventration and organoaxial gastric volvulus. Laparotomy revealed an eventrated left hemidiaphragm with a distended, volvulated stomach.
Acute gastric volvulus is a rare cause of persistent vomiting in infancy or childhood and is due to an abnormal rotation of one part of the stomach around another. There are two main anatomical forms of gastric volvulus.1 In the more common, organoaxial volvulus, the stomach rotates around an axis connecting the cardia and the pylorus, and in the less common, mesenteroaxial volvulus, the stomach rotates around a transverse axis connecting the middle of the greater and lesser curvatures (fig 3). In an infant with unexplained vomiting, gastric volvulus should always be suspected on a plain abdominal radiograph, when associated with a left diaphragm anomaly.2
Thanks to Ashwin Prakash for the schematic representation in fig 3.