Home | About Us | Current Issue | Ahead of print | Archives | Search | Instructions | Subscription | Feedback | Editorial Board | e-Alerts | Login 
Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
 Users Online:279 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size

Year : 2010  |  Volume : 15  |  Issue : 1  |  Page : 28-29

Acute gastric volvulus in operated cases of tracheoesophageal fistula

Department of Paediatric Surgery, SETH G.S.M.C. and K.E.M. Hospital, Mumbai, India

Date of Web Publication9-Sep-2010

Correspondence Address:
Milind Joshi
B-7, Sai-Sadan Apts, Sai-Baba Complex, CIBA India Road, Goregaon (East), Mumbai - 400 063
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-9261.69139

Rights and Permissions



A report of two neonates of esophageal atresia with tracheoesophageal fistula who had acute gastric volvulus in the postoperative period and required gastropexy after correction of the volvulus. Such postoperative complication has not been reported in the literature so far.

Keywords: Acute gastric volvulus, complications, esophageal atresia, tracheoesophageal fistula

How to cite this article:
Joshi M, Parelkar S. Acute gastric volvulus in operated cases of tracheoesophageal fistula. J Indian Assoc Pediatr Surg 2010;15:28-9

How to cite this URL:
Joshi M, Parelkar S. Acute gastric volvulus in operated cases of tracheoesophageal fistula. J Indian Assoc Pediatr Surg [serial online] 2010 [cited 2022 Dec 7];15:28-9. Available from: https://www.jiaps.com/text.asp?2010/15/1/28/69139

   Introduction Top

Congenital esophageal atresia and tracheoesophageal fistula (EA/TEF) is commonly associated with other congenital anomalies. [1] Gastric volvulus can present as an acute abdomen in the infancy. [2],[3],[4],[5],[6] However, secondary acute gastric volvulus in the operated tracheoesophageal fistula has not been reported so far.

   Case Reports Top

Case 1

A full-term male neonate was operated for EA/TEF (Type C). On the 4 th postoperative day, he had sudden epigastric distension and hematemesis. After adequate resuscitation, surgical exploration, and reduction of the gastric volvulus, a gastropexy was done. There was no other pathology detected in the stomach that would predispose it to volvulus.

Case 2

This was again a full-term neonate operated for EA/TEF repair. On the 5 th postoperative day he developed sudden onset epigastric distension. Abdominal radiographs revealed dilated stomach shadow. Upper gastro-intestinal contrast examination revealed organoaxial volvulus of the stomach [Figure 1]. Exploratory laparotomy revealed similar findings as that of the first case and similar surgery was done. The child was thriving at 1-year follow-up.
Figure 1 :Upper GI contrast study showing developing organoaxial gastric volvulus with dilated stomach with Ryle's tube in situ

Click here to view

   Discussion Top

In EA/TEF, the incidence of associated congenital anomalies is 50%-70% [1] and gastrointestinal anomalies are reported to be seen in 24% of the cases. [2] Acute gastric volvulus frequently presents in children. Most case reports and the largest single institutional study identify neonates and infants younger than 6 months as the most common age group of children with acute gastric volvulus of the stomach. [3]

There have been less than 600 reported cases of gastric volvulus in children till 2008. [4] The normal stomach is fixed and prevented from volvulus by the ligamentous attachments of the stomach as gastrohepatic, gastrocolic, gastrophrenic and gastrosplenic ligaments. The relative fixity of the pylorus and gastroesophageal junction also helps to maintain the normal position of the stomach.

The volvulus of the stomach is primary when these ligamentous attachments are poor or absent. It can also occur in the presence of normal ligamentous attachments. [3] It can also be secondary to congenital diaphragmatic hernia, hiatus hernia, diaphragmatic eventration, paraesophageal hernia, wandering spleen, with distended stomach and gastric outlet obstruction or with malrotation of the intestine. [5],[6] It may also occur secondary to Nissen's fundoplication. [7] The volvulus can be of organoaxial, mesentericoaxial, or mixed type depending on the axis on which the stomach rotates onto itself. [8] The organoaxial type is more commonly found in the primary type. [9] Most of the mesentericoaxial volvulus in children is secondary to diaphragmatic hernia and paraesophageal hernia. [4] The diagnosis is usually by clinical suspicion in the setting of underlying pathology and by upper GI contrast study. Gastropexy is the commonly preferred surgery either open or laparoscopically. [10]

Both our cases reported here were diagnosed to be having EA/TEF in their routine postnatal evaluation. Both the patients had large TEF and the esophageal repair had been done after the mobilization of the upper and lower esophageal pouch and had uneventful perioperative course. Both the patients were expected to have good recovery from the TEF when this unexpected pathology struck on postoperative day 4 and day 5, respectively. In the first case, the neonate developed sudden onset epigastric distension and hematemesis. Roentgenogram of the abdomen and chest was normal. But because of the suspicion of the gastric volvulus, exploration was done, which revealed the organoaxial gastric volvulus with normal attachments and no other pathology. The esophageal anastomosis was also intact, which was confirmed on dye study after the correction of the gastric volvulus.

The second neonate developed same symptoms on the 5 th postoperative day, with abdomen radiograph showing large stomach shadow and the presence of epigastric lump, hence upper GI dye study was done to ascertain the diagnosis of gastric volvulus. It confirmed the organoaxial type of the volvulus. Emergency exploration and three-point gastropexy were done. The patient made uneventful recovery from both the surgeries and was doing well at one year of follow up.

The literature on gastric volvulus mentions secondary gastric volvulus as more common; however, TEF does not figure in the list of etiology. [3] The occurrence of gastric volvulus in our patients was really surprising and no definite explanation can be given. We do not know whether it is a mere coincidence of the two pathologies or it could be attributed to the preferential passage of air into the stomach in the postnatal period before the ligation of the large TEF leading to the stretching of the supporting ligaments and predisposing it for volvulus. Another reason could be the esophageal anastomosis stretching the esophagogastric junction and acting as a fixed point causing stomach volvulus. The transanastomotic tube placed in the stomach for free drainage has also not helped to prevent the pathology. It won't be overemphasizing here that the pathogenesis of the mechanisms of volvulus described for both types was observed to be occurring simultaneously in our cases leading to the organoaxial volvulus in the absence of ligamentous abnormality and TEF acting as a predisposing factor. However, the incidence of this pathology may appear as mere coincidence because of the rarity of its occurrence.

We feel that although not reported till now, gastric volvulus can occur in operated cases of the TEF and prompt management should be done if the pathology is suspected. This is the first report of such gastric volvulus occurring in the setting of TEF.

   References Top

1.Holder TM, Clout DT, Lewis JE Jr, Pilling GP. Esophageal atresia and tracheo-esophageal fistula: A survey of its members by the surgical section of American Academy of Pediatrics. Pediatrics 1964;34:542-5.  Back to cited text no. 1      
2.Spitz L, Kiely E, Brereton RJ, Drake D. Management of esophageal atresia. World J Surg 1993;17:296-9.  Back to cited text no. 2  [PUBMED]    
3.Basaran UN, Inan M, Ayhan S. Acute gastric volvulus due to deficiency of the gastro-colic ligament in a new born. Eur J Pediatr 2002;12:111-5.   Back to cited text no. 3      
4.Cribbs R, Gow K, Wulkan M. Gastric volvulus in infants and children. Pediatrics 2008;122:e752-62.  Back to cited text no. 4      
5.Karande T, Oak S, Karmarkar S, Kulkarni B, Deshmukh S. Gastric volvulus in childhood. J Postgrad Med 1997;43:46-7.  Back to cited text no. 5  [PUBMED]  Medknow Journal  
6.Mayo A, Erez I, Lazar L, Rathaus V, Konen O, Freud E. Volvulus of the stomach in childhood: The spectrum of the disease. Pediatr Emerg Care 2001;17:344-8.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Kuenzler K, Wolfson P, Murphy S. Gastirc volvulus after laparoscopic Nissan's fundoplication with gastrostomy. J Pediatr Surg 2003;38:1241-3.  Back to cited text no. 7      
8.Miller D, Pasquale M, Seneca R, Hodin E. Gastric volvulus in pediatric population. Arch Surg 1991;126:1146-9.  Back to cited text no. 8      
9.Honna T, Kamii Y, Tsuchida Y. Idiopathic gastric volvulus in infancy and childhood. J Pediatr Surg 1990;25:707-10.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Darani A, Mendoza-Sagaon M, Reinberg O. Gastric volvulus in children. J Pediatr Surg 2005;40:855-8.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  


  [Figure 1]

This article has been cited by
1 Acute gastric volvulus six years after PEG-tube placement
Jonathan Hencke, Gabriel Nonnenmacher, Steffan Loff
Journal of Pediatric Surgery Case Reports. 2022; 81: 102263
[Pubmed] | [DOI]
2 Gastric volvulus in children: Our experience
Mirza, B. and Ijaz, L. and Sheikh, A.
Indian Journal of Gastroenterology. 2012; 31(5): 258-262
3 Gastric volvulus in children: our experience
Bilal Mirza,Lubna Ijaz,Afzal Sheikh
Indian Journal of Gastroenterology. 2012; 31(5): 258
[Pubmed] | [DOI]


Print this article  Email this article
Previous article Next article


   Next article
   Previous article 
   Table of Contents
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (360 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Case Reports
    Article Figures

 Article Access Statistics
    PDF Downloaded122    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer | Privacy Notice

  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05