Gastric volvulus with partial and complete gastric necrosis
A 6-month-old girl was brought to the emergency with sudden abdominal distention, nonbilious vomiting, and restlessness for three days. She did not have any similar history of vomiting, respiratory complaints, or abdominal distension in the past. No similar illness ran in her family. On admission, dehydration was present with a pulse rate of 120/min. Epigastrium was full. Per rectal examination was normal. Straight X-ray revealed left-sided eventration of the diaphragm with prominent gastric bubble with air-fluid levels.\nRyle's tube aspirate was blood-stained and scanty in amount. The patient was resuscitated with intravenous fluids and antibiotics. On exploration, mesenteroaxial volvulus of the stomach was noted. The whole of stomach, sparing the pyloric end, was necrotic. The necrotic stomach was excised and sent for histopathology. Duodenum was mobilized. A pyloric tube was made after pyloromyotomy and oesophago-pylorostomy was performed in a single-layer interrupted fashion with polyglactin 4-0 stitches. Plication of the diaphragm was done with 3-0 polypropylene stitches in an interrupted fashion. Feeding jejunostomy was additionally performed.\nFeeding was started from postoperative day 3 through the jejunostomy tube. A contrast study performed after two weeks showed no anastomotic leak Subsequently, the patient was allowed oral diet and discharged. On follow-up 15 days and 6 months later, the patient is doing well.