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\begin{document}

\title{Acute gastric volvulus mimicking features of gastroenteritis in a
5-year-old girl}



\author[1]{Manami  Ueshima}%
\affil[1]{Kameda Medical Center}%


\vspace{-1em}



  
  \date{June 16, 2024}


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\textbf{CASE DESCRIPTION}

A 5-year-old girl presented to a hospital at night with intermittent
vomiting and abdominal pain since the morning. She was exhausted and
unable to drink or eat properly but had a normal bowel movement that
day. The physician performed abdominal X-ray imaging, which revealed
abnormal gas distribution (Fig. 1-a,b). However, her symptoms remained
stable. Thus, she was diagnosed with early gastroenteritis, and the
physician decided to discharge her. But she was transferred to our
hospital the next day with worsening symptoms. She had a history of
undergoing surgery for a congenital diaphragmatic hernia at birth. Her
physical examination indicated a distended abdomen with periumbilical
tenderness on palpation. Furthermore, abdominal X-ray revealed the
absence of gas (Fig. 1-c,d), and contrast-enhanced abdominal computed
tomography scan revealed an enlarged stomach with rotation and a
right-sided spleen (Fig. 2). An indwelling nasogastric tube was
successfully inserted under fluoroscopy, and the symptoms of the patient
dramatically improved after removing \textgreater{}1 liter of gastric
contents. Finally, she was diagnosed with acute gastric volvulus and a
wandering spleen.

\textbf{DISCUSSION}

Vomiting and abdominal pain are common symptoms of gastroenteritis in
children. However, it is important to carefully examine them in cases of
intestinal obstruction. Notably, intussusception is the most widely
recognized disease causing these symptoms in young
children.\textsuperscript{1)} Nevertheless, acute volvulus may also
occur, especially in children with adjacent organ
deformities.\textsuperscript{2)} In the present case, the patient had a
history of undergoing surgery for a diaphragmatic hernia. Her symptoms
worsened dramatically without treatment, and this was a life-threatening
condition.\textsuperscript{3)} Therefore, if intestinal obstruction is
suspected, we recommend not hesitating to perform additional diagnostic
imaging.

\textbf{ACKNOWLEDGEMENT}

Nothing to disclose.

\textbf{CONFRICT OF INTEREST STATEMENT}

No conflicts of interest.

\textbf{FUNDING}

None declared.

\textbf{ETHICAL APPROVAL}

Not applicable.

\textbf{CONSENT}

Informed consent was obtained from the patient's family.

\textbf{GUARANTOR}

Manami Ueshima.

\textbf{REFERENCES}

\begin{enumerate}
\tightlist
\item
  Tessi R, Haddad S, Oze K, et al. A child's acute intestinal
  intussusception and literature review. \emph{Glob Pediatr Health} .
  2021;(8)2333794X211059110. DOI:~10.1177/2333794X211059110
\item
  Cribbs RK, Gow KW, Wulkan ML. Gastric volvulus in infants and
  children. \emph{Pediatrics.} 2008;122(3):e752-e762.
  DOI:~10.1542/peds.2007-3111
\item
  Costa K, Saxena A. Management and outcomes of gastric volvulus in
  children: a systematic review. \emph{World J Pediatr} .
  2019;15(3):226-234. DOI:~10.1007/s12519-019-00244-4
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