Gastric volvulus with massive necrosis in the setting of CDH requires a high index of clinical suspicion for appropriate diagnosis. Literature has only few reported cases. Delay in diagnosis can lead onto significant morbidity such as loss of storage capacity of the stomach. Plain X-ray of the chest with both domes of diaphragm in erect posture is needed to clinch an early diagnosis . In equivocal cases, an upper gastrointestinal contrast study is helpful . Also, CECT scan of the chest with three dimensional reconstructions can clearly show the herniation of abdominal contents into the chest cavity . Abnormal position of the stomach with non-enhancing wall is suggestive of gastric volvulus with compromised blood supply .
In the occurrence of massive gastric necrosis, a near total or total gastrectomy may be required, with restoration of esophago-intestinal continuity by anastomosis with residual stomach or interposition of a loop of the small intestine . In our patient, part of the antrum and fundus was viable, which was used to reconstruct the residual stomach. The stomach receives blood supply via the right and left gastric arteries and also the right and left gastro-epiploic arteries. This ensures an excellent and extensive collateral supply allowing organ preservation even in the setting of massive necrosis . Hence, the aim is to do conservative resection, removing only the absolutely nonviable tissue and allow the collaterals to take over the salvage of the gastric remnant. Nevertheless, gastric volvulus has a high mortality rate of 30–50%, and up to 60% when strangulation or significant vascular compromise is present. An early diagnosis and prompt surgical treatment is required for an uneventful recovery .
Shukla et al.  report the rarity of massive gastric necrosis in the literature. Of the 2 cases reported in their series, one underwent total gastrectomy and the other partial resection and reconstruction of the stomach. Our case is similar to the second case in terms of gastric salvage, but different from the associated diaphragmatic eventration in both their cases whereas our child had a diaphragmatic hernia.
Strengths of this report include the timely sequence of diagnosis, surgical management and recovery. The inability to document the actual area of vascular demarcation before surgery is a limitation of this case report.