Gastric volvulus in childhood: potential use of gut tonometry

Acute gastric volvulus is a rare surgical emergency in childhood and, if not diagnosed and treated promptly, may result in gastric ischaemia, perforation and death. We report a case of an organoaxial gastric volvulus occurring in a four-year-old girl whose initial management consisted of resuscitation, surgical reduction and gastropexy. Despite the absence of clinical and biochemical signs to suggest gastric ischaemia, information obtained post-operatively from gastric tonometry implied the stomach to be severely ischaemic; serial pHi values were all less than 7.0. Repeat operation 48 hours later found an infarcted stomach and a total gastrectomy was performed. We conclude that gastric tonometry may be useful in managing children who undergo emergency surgery where gut viability is in question.