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

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Abstract

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 follow-up 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.

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  1. Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster NHS Foundation Trust, Imperial College London, London, United Kingdom

    Karina Miura da Costa & Amulya K. Saxena

  2. Division of Pediatric Surgery, Department of Anatomy and Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Prêto, Brazil

    Karina Miura da Costa

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KMC contributed to concept and design, acquisition of data, analysis and interpretation of data, and drafting of the article. AKS contributed to concept and design, acquisition of data, analysis and interpretation of data, and revising of the article critically for important intellectual content. Both authors approved the final version of the manuscript to be published.

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da Costa, K.M., Saxena, A.K. Management and outcomes of gastric volvulus in children: a systematic review. World J Pediatr 15, 226–234 (2019). https://doi.org/10.1007/s12519-019-00244-4

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