A case of acute gastric volvulus associated with eventration of the diaphragm in a previously well 6 year old child is reported. The child presented with acute abdominal pain, abdominal distension and vomiting. At operation, mesentero-axial type gastric volvulus was found, associated with laxity of the gastro-splenic, gastrohepatic and gastrocolic ligaments and eventration of the left hemidiaphragm. Rapid recovery followed surgery that included release of distension and fixation of the stomach to the anterior abdominal wall. There has been no evidence of recurrence on a 2 year follow-up.
A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.