Gastric volvulus associated with congenital diaphragmatic hernia

Gastric volvulus may present as a surgical emergency due to the risk of rapid deterioration, gastric necrosis and perforation. Undiagnosed congenital diaphragmatic hernia (CDH) is a rare, but established association. We recount four cases in paediatric practice and provide relevant surgical and radiological learning points in the identification and management of this condition. In patients with undiagnosed CDH, acute decompensation may occur secondary to mesenteric-axial gastric volvulus and acute gastric dilatation. Plain radiographs, computed tomography scans and focused ultrasound are important diagnostic modalities and tools for preoperative planning. Nasogastric tube decompression can be a life-saving, stabilising manoeuvre, while surgical repair of the diaphragmatic defect provides definitive management.