Gastric volvulus with partial and complete gastric necrosis
A 10-month-old male child admitted with features of acute intestinal obstruction with bilious vomiting and occasional hematemesis for last two days. There was difficulty in placing the Ryle's tube even on repeated attempts. The patient was having epigastric fullness. There was history of repeated chest infections in the past for which the patient was treated with antibiotics by a local physician. A babygram showed diaphragmatic defect with a large single air-fluid level []. On exploration, organo-axial gastric volvulus with total necrosis of the stomach was detected [] along with eventration of the left hemidiaphragm. The spleen and small bowel were lying high up because of eventration of diaphragm. Total gastrectomy with closure of duodenal stump and esophagojejunostomy (Roux loop) [] and jejunojejunostomy was done and diaphragmatic eventration was repaired. The resected specimen was sent for histopathologic analysis. The affected hemidiaphragm was plicated with 3-0 polypropylene stitches in interrupted fashion.\nA postoperative contrast study done on day 5 revealed a smooth passage of dye without leakage or retention. From the same day, feeds were started per oral and the patient tolerated the feeds well. The patient was discharged on the eighth postoperative day. The histopathology report on Haematoxylin and Eosin stain in high power (i.e. 400X magnification) showed necrosis along with infiltration of inflammatory cells.\nOn follow-up after 15 days, 3 months, and 12 months, the patient is doing well and gaining appropriate weight.