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Case Report *Corresponding author Punit Kumar Srivastava, Department of Surgery, S Unusual Association of Gastric N Medical College, Agra, 282002, UP, India, Email: Submitted: 24 February 2016 with Hypertrophic Accepted: 01 March 2016 Published: 07 March 2016 ISSN: 2379-0911 Pyloric : A Rare Entity Copyright Punit Kumar Srivastava*, Richa Jaiman, Juhi Singhal and © 2016 Srivastava et al. Surendra Pathak OPEN ACCESS Department of Surgery, S N Medical College, India Keywords • Abstract • Hypertrophic Gastric volvulus is extremely rare in neonates and is to be considered in of recurrent in pediatric age group. There are various predisposing congenital and acquired factors that lead to gastric volvulus like absence of gastrocolic ligament attachment, abnormal fixation; diaphragmatic and eventration of diaphragm etc. We describe unusual association of gastric volvulus with infantile hypertrophic pyloric stenosis. The patient was well managed by pyloromayotomy and anterior gastropexy with gastrostomy. This is the very case of infantile hypertrophic pyloric stenosis associated with gastric volvulus and very few cases described in world literature.

INTRODUCTION

Acute gastric volvulus in childhood is uncommon and very such as anomalies of the gastric ligaments and those associated rare in neonates [1]. Delay in the diagnosis can result in gastric [1,4]. Most cases are secondary to diaphragmatic complications

with gastric malfixation as the asplenia/polysplenia syndrome whichischemia includes and perforation failure of[2]. attachment Gastric volvulus of gastric was first ligament described or [5,6]. Organ axial gastric volvulus is the most common form, in by Berti in 1886 [3].There are various etiology of gastric volvulus which the rotates about its cardio pyloric line [6]. Gastric volvulus is defined as an abnormal degree of rotation elongation of gastric fixation, disorder of gastric anatomy or stomach is of one part of the stomach around another [7]. The normal function and abnormalities of adjacent organ like diaphragm and fixed and is prevented from abnormal rotation spleen .The diagnosis was suspected on clinical ground and was by the four gastric ligaments and diaphragm which serves to confirmed by barium meal examination. Case presentation A full term 22 days old male child weight 2.5 kg presented with recurrent non bilious vomiting, refusal to feed and excessive crying with mild . On abdominal examination there was no visible and no lump palpable. Plain X- Ray abdomen showed, a large gastric shadow, with minimal air fluid level in the rest of abdomen. Serum Electrolyte was aand horizontally hyponatremia. placed Ultra stomach sound along abdomen with gastric showed distention dilatation lying of stomach and was inconclusive. Barium meal examination showed in upper abdomen with thin line of barium passing through gastrosplenicpylorus (Figure ligament 1). Per along operative with hypertrophic finding was pyloric dilated, stenosis mobile, twisted stomach with absence of gastro hepatic ligament and lax in(Figure follow 2).up. Pyloromayotomy with feeding gastrostomy was performed and patients recovered uneventfully. Patient did well DISCUSSION Gastric volvulus on upper gastrointestinal study. Gastric volvulus is a rare condition in the neonatal period Figure 1

Cite this article: Srivastava PK, Jaiman R, Singhal J, Pathak S (2016) Unusual Association of Gastric Volvulus with Hypertrophic Pyloric Stenosis: A Rare Entity. J Surg Transplant Sci 4(2): 1024. Srivastava et al. (2016) Email:

Central Bringing Excellence in Open Access are newer modalities [20,21]. Though nonsurgical treatment has been described for primary gastric volvulus [22], however the remote possibility of gastric perforation and gangrene still remains (which has also being seen in one of our case) hence surgical treatment is preferably. The similar previous reports of that rare coexistence also described. CONCLUSION Gastric volvulus in neonate is extremely rare very rare and

by excluding other common causes of neonatal vomiting. It is mandatoryposses a diagnostic to rule out dilemma. other cause High of index gastric of suspicionoutlet obstruction remains Figure 2 like hypertrophic pyloric stenosis and malrotation etc. Diagnostic volvulus. Hypertrophic pyloric stenosis associated with gastric treatment should be surgical intervention i.e. gastropexy either confirmation is mostly made by upper GI contrast study. Ideal prevent abnormal displacement of abdominal viscera and gastric by open or laparoscopic technique. volvulus. Laxity of stomach ligament, pyloric obstruction leading REFERENCES to chronic gastric dilatation, hiatus hernia, other diaphragmatic [8], eventration [9] of diaphragm, adhesions serve as 1. Newborn surgery, Oxford, 1st predisposing factors for volvulus of stomach. A tight wrap after Howard ER, Stringer MD. Butterworth-Heinemann, Gastric volvulus. Nissen’s fundoplication can also leads to gastric volvulus [10]. 2. ed. 1996. 272-276. The clinical symptoms depend on the extent and degree of Miller DL, Pasquale MD, Seneca RP, Hodin E. Gastric volvulus in the volvulus. The amount of twist varies from 180 deg to 360 deg 3. pediatricBerti A. Sigolare population. altorti Arch glamento Surg. 1991; dell 126: esofagocol 1146-1149. dudeno segitto da and is associated with closed loop obstruction and the risk of rapida morte. Gazz Med Ital Prov Ver. 1866; 9:139 strangulation [11]. Intermittent or chronic gastric volvulus 4. may cause diverse gastrointestinal symptoms in children [12]. Lesser degrees of torsion are probably common and associated Mutabagani KH, Teich S, Long FR. Primary intrathoracic gastric 5. volvulus in a newborn. J Pediatr Surg. 1999; 34: 1869-1871. with transient vomiting but spontaneous resolution is known. N. Digestive tract disorders associated with asplenia/polysplenia Acute and complete gastric volvulus is most commonly seen Nakada K, Kawaguchi F, Wakisaka M, Nakada M, Enami T, Yamate in the infant, in contrast to the chronic and partial form, which 6. occurs more often in older children and adults [1,4]. Severe syndrome. J Pediatr Surg. 1997; 32: 91-94. epigastric pain and distension, violent unproductive and Chang SW, Lee HC, Yeung CY, Chan WT, Sheu JC, Wang NL, et al. Gastric inability to pass a nasogastric tube comprise the classical triad 7. volvulusTanner NC. in children.Chronic andActa recurrent Paediatr Taiwan.volvulus 2006; of the 47: stomach 18-24. with late

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Cite this article Srivastava PK, Jaiman R, Singhal J, Pathak S (2016) Unusual Association of Gastric Volvulus with Hypertrophic Pyloric Stenosis: A Rare Entity. J Surg Transplant Sci 4(2): 1024.

J Surg Transplant Sci 4(2): 1024 (2016) 3/3