Episodic apnea: gastroesophageal reflux associated with gastric organo-axial malrotation: a case report

• Published in: Journal of medical case reports Vol. 16; no. 1; p. 133
• Main Authors: Turk, Sena, Gokce, Sule, Koc, Feyza Umay
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.04.2022; BioMed Central; BMC
• Subjects: Abdomen; Apnea; Auscultation; Babies; Birth weight; Case Report; Case reports; Child; Child, Preschool; Cyanosis; Disease; Electroencephalography; Enteral nutrition; Epilepsy; Esophagus; Failure to thrive; Failure to Thrive - etiology; Female; Gastric organo-axial malrotation; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Health aspects; Hematemesis; Hospitalization; Humans; Infant; Infants; Oxygen saturation; Pediatrics; Sleep apnea; Sleep disorders; Stomach; Teenage girls; Vomiting; Vomiting - complications; Whooping cough; Gastroesophageal reflux; Gastric organo-axial malrotation; Apnea
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-022-03367-x

Gastroesophageal reflux is a normal physiologic process occurring several times a day in healthy infants. On the other hand, symptoms such as failure to thrive, feeding or sleeping problems, chronic respiratory distress, persistent forceful vomiting, and choking may indicate reflux associated with underlying anatomic, neurological, or infectious abnormalities. Gastric malrotation is an extremely rare disorder in the pediatric population and one of the anatomic causes associated with severe reflux, which could lead to serious complications. In such cases, life-threatening symptoms overlapping with other diseases cause delayed diagnosis and treatment. We report a 2.5-month-old white girl diagnosed with gastric malrotation-related reflux, which caused inadequate weight gain, feeding difficulties, episodes of apnea with cyanosis, and choking after successive coughing, hence previously misdiagnosed as epilepsy and pertussis. Life-threatening symptoms in an infant with reflux suggest anatomic, neurological, or infectious conditions. Gastric malrotation is more common than generally thought and specifically looked for in young children with severe reflux symptoms, and should be diagnosed and treated as soon as possible.