The "upside-down stomach" is a rare form of organo-axial neonatal volvulus, which occurs because of absent or attenuated anatomical anchors and abnormal motility of the stomach. It is considered a surgical emergency that requires immediate correction.
We report a previously undescribed etiology of gastric neonatal volvulus caused by an extremely distended transverse colon, secondary to rectal atresia. The etiologic and diagnostic considerations are discussed. Gastropexy in the form of gastrostomy proved to be an effective treatment.
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