A Case of Acute Gastric Volvulus Resulting in Panperitonitis Due to Gastric Perforation

Abstract

The patient was a two-year-old girl who had been treated for recurrent vomiting for three days. She was brought to our hospital after her previous doctor suspected gastrointestinal perforation due to sudden abdominal distension. When she arrived at our hospital, her face was pale, her vitality was poor, and she had a peripheral cold sensation. Her pulse rate was 200/min, her blood pressure was 60/42 mmHg, her respiratory rate was 43/min, and she was in shock. Contrast-enhanced computed tomography (CT) of the abdomen showed a large amount of free air and ascites along with findings of gastric volvulus. Emergency laparoscopic surgery was performed. The gastric volvulus was corrected laparoscopically. Because the site of perforation was challenging to identify, we changed the procedure to open laparotomy. A pinhole perforation was found at the upper gastric corpus due to detachment of the omentum. Wedge-shaped resection was performed around the perforation, and the stomach was fixed to the abdominal wall. No migrating spleen was observed. The postoperative recovery from disseminated intravascular coagulation and improvement of gastric peristalsis took a few days, but she gradually improved. She was discharged on the 19th postoperative day. Since her discharge from the hospital, there has been no recurrence of volvulus. There have been several reports on gastric perforation associated with acute gastric volvulus. Since there have been some reports of death due to the rapid and severe onset of symptoms, a prompt diagnosis and treatment are required.