quiz prevent recurrent gastric volvulus

[Admin]

A nine-month old baby presents with nonbilious vomiting and dehydration. An upper gastrointestinal contrast study is obtained and demonstrates an organoaxial gastric volvulus with the majority of the stomach located in the mediastinum. At the time of the operation the viable stomach is untwisted and reduced into the abdominal cavity.

To prevent recurrent gastric volvulus, the hiatal hernia should be closured, and

A nothing further.

B anterior gastropexy.

C partial fundoplication.

D full fundoplication.

E omentectomy.

[Admin]

B

correct

Acute gastric volvulus is a surgical emergency with a seven percent mortality.

In organoaxial volvulus, the stomach rotates along an axis drawn between the gastroesophageal junction and pylorus resulting in the stomach being horizontal. A mesentericoaxial volvulus occurs when the stomach rotates along an axis that bisects it along its body.

Gastric volvulus is described as primary when it occurs in a patient without other anatomic defects and secondary when it is associated with anatomic anomalies such as diaphragmatic hernia, eventration, hiatal hernia, or a pericardial defect from previous cardiac surgery.

Acute gastric volvulus typically presents in children less than five years of age with abdominal pain, nonbilious emesis and epigastric distention. Chronic gastric volvulus is more common in children less than one year of age and presents with feeding difficulties, emesis and growth retardation. Medical therapy has been described in chronic gastric volvulus (usually in regions outside of North America) but its long term outcomes have not been described.

A review of the world’s literature on gastric volvulus noted that simple reduction of the stomach and repair of associated defects results in a seven percent rate of recurrence. Therefore it is recommended that anterior gastric fixation should be performed for cases of primary gastric volvulus. The two ways to accomplish fixation are through a gastropexy or a gastrostomy tube. There is no evidence that an antireflux procedure, partial or full, is necessary at the time of volvulus repair for either primary or secondary volvulus. There is no role for omentectomy in this situation.

[Sharon]

B

[Admin]

B

correct

Acute gastric volvulus is a surgical emergency with a seven percent mortality.

In organoaxial volvulus, the stomach rotates along an axis drawn between the gastroesophageal junction and pylorus resulting in the stomach being horizontal. A mesentericoaxial volvulus occurs when the stomach rotates along an axis that bisects it along its body.

Gastric volvulus is described as primary when it occurs in a patient without other anatomic defects and secondary when it is associated with anatomic anomalies such as diaphragmatic hernia, eventration, hiatal hernia, or a pericardial defect from previous cardiac surgery.

Acute gastric volvulus typically presents in children less than five years of age with abdominal pain, nonbilious emesis and epigastric distention. Chronic gastric volvulus is more common in children less than one year of age and presents with feeding difficulties, emesis and growth retardation. Medical therapy has been described in chronic gastric volvulus (usually in regions outside of North America) but its long term outcomes have not been described.

A review of the world’s literature on gastric volvulus noted that simple reduction of the stomach and repair of associated defects results in a seven percent rate of recurrence. Therefore it is recommended that anterior gastric fixation should be performed for cases of primary gastric volvulus. The two ways to accomplish fixation are through a gastropexy or a gastrostomy tube. There is no evidence that an antireflux procedure, partial or full, is necessary at the time of volvulus repair for either primary or secondary volvulus. There is no role for omentectomy in this situation.