Gastric Volvulus Manifesting as Infantile Wheezing

Gastric volvulus is a rare disease in the pediatric population. Its clinical presentation is exceedingly variable, and without a high index of suspicion, delayed or missed diagnosis is not uncommon as illustrated by this report of a 13-month-old boy with a puzzling presentation of chronic wheezing and cough for 1 year. There were no gastrointestinal symptoms. The symptoms were attributed to bronchiolitis, pneumonia, laryngomalacia, or reactive airway disease by several practicing physicians. A detailed history revealed that the wheezing got worse after large meals. This information prompted an upper gastrointestinal contrast study, which led to the identification of organoaxial gastric volvulus and coexisting gastroesophageal reflux. The respiratory symptoms resolved dramatically after antireflux medications and lifestyle modification for gastroesophageal reflux. This report highlights chronic gastric volvulus in the differential diagnosis of infantile wheezing, particularly when the wheezing is present very early in life and associated with feeding.