RT Book, Section
A1 Caty, Michael G.
A1 Escobar, Mauricio A.
A2 Ziegler, Moritz M.
A2 Azizkhan, Richard G.
A2 Allmen, Daniel von
A2 Weber, Thomas R.
SR Print(0)
ID 1100434206
T1 Stomach: Obstruction, Microgastria, Foreign Body, and Peptic Ulcer
T2 Operative Pediatric Surgery, 2e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-162723-8
LK accesssurgery.mhmedical.com/content.aspx?aid=1100434206
RD 2024/04/20
AB Organoaxial  volvulus  is  the  most  common  reported  type  of  gastric  volvulus  in  childhood.  Children  do  not  reliably  demonstrate  the  triad  of  Borchardt  (unproductive  retching,  localized  epigastric  distension,  and  inability  to  pass  a  nasogastric  tube).  Associated  diaphragmatic  abnormalities  should  be  assessed.Pyloric  atresia  (PA)  is  an  extremely  rare  cause  of  intestinal  obstruction  and  may  occur  in  combination  with  epidermolysis  bullosa.A  completely  obstructing  antral  web  is  treated  with  gastrotomy  and  circumferential  web  excision  with  oversewing  of  the  mucosal  remnant.The  need  for  surgical  therapy  is  dictated  by  the  severity  of  microgastria.  If  drooling,  reflux,  or  failure  to  thrive  persists,  gastric  augmentation  should  be  performed.  The  technical  aspects  of  the  procedure  include  creating  a  loop  from  the  Roux-en-Y  limb  of  the  jejunum.  This  pouch  is  anastomosed  to  the  side  of  the  diminutive  stomach.Most  gastric  duplication  cysts  can  be  bluntly  dissected  off  adjacent  organs.  Dissection  begins  in  the  common  muscular  plane  between  the  stomach  and  the  duplication.  The  duplication  is  peeled  off  the  mucosa  of  the  stomach  and  removed.The  most  common  type  of  gastric  tumor  in  childhood  is  a  teratoma.Recommendations  for  button  battery  removal  from  the  stomach  have  changed.  Typically,  they  pass  on  their  own.  Intervention  is  reserved  for  large  batteries  in  small  children  (<6  years  old)  or  if  swallowed  concomitantly  with  a  magnet.  Endoscopy  is  preferred  but  laparotomy  and  gastrotomy  for  removal  may  be  necessary.Operative  interventions  should  be  considered  for  any  persistently  bleeding  child  with  peptic  ulcer  disease.  Some  clinical  indications  for  operative  treatment  are  loss  of  50%  of  the  estimated  blood  volume  in  8  hours,  hemodynamic  instability,  and  the  presence  of  a  visible  vessel  on  endoscopy.