TY - CHAP M1 - Book, Section TI - Stomach: Obstruction, Microgastria, Foreign Body, and Peptic Ulcer A1 - Caty, Michael G. A1 - Escobar, Mauricio A. A2 - Ziegler, Moritz M. A2 - Azizkhan, Richard G. A2 - Allmen, Daniel von A2 - Weber, Thomas R. PY - 2014 T2 - Operative Pediatric Surgery, 2e 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/12 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1100434206 ER -