Pediatric Mesenteroaxial Gastric Volvulus

  • Etiology:
    — Stomach twists on its mesentery and stomach is rotated around its short axis from lesser to greater curvature
    — Often associated with diaphragmatic defect
  • Imaging UpperGI: Stomach appears upside-down with antrum and pylorus superior to fundus and proximal body
  • Note: Greater curvature of stomach should never be above lesser curvature of stomach
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: Borchardt triad – sudden epigastric pain, intractable retching, inability to pass nasogastric tube into stomach

Radiology Cases of Mesenteroaxial Gastric Volvulus

AXR and upper GI of mesenteroaxial gastric volvulus
AXR AP (above left) shows a distended air-filled stomach which on the AXR upright (above right) has a large air-fluid level within it. AP image from an upper GI (below) shows that by following the course of the feeding tube the stomach appears to be upside down with the pylorus of the stomach located superiorly to the gastroesophageal junction and the tip of the feeding tube to be in the second part of the duodenum.
Upper GI of pediatric mesenteroaxial gastric volvulus
Lateral image from an upper GI exam (left) shows a fixed indentation on the posterior aspect of the mid-esophagus. AP images from the upper GI exam (right) show the stomach appears to be upside-down with the antrum and pylorus superior to the fundus and proximal body of the stomach. Note how the pylorus of the stomach is located superiorly to the gastroesophageal junction.

Radiology Cases of Horizontal Stomach Mimicking Mesenteroaxial Gastric Volvulus

Upper GI of pediatric horizontal stomach
AP images from an upper GI exam show the stomach tilted horizontally in orientation. The antrum and pylorus are not superior to the fundus and proximal body. The ligament of Treitz is in a normal position in the left upper quadrant.