Volvulus (peds)

Background

• 2 types: Sigmoid and cecal volvulus
• Surgical emergency
• Can occur at any time
  • 1st week of life: 33%
  • 1st month of life: 50%
  • 1st year of life: 85%

Diagnosis

Clinical Presentation

• Classic Triad: abdominal pain, increased abdominal distention, constipation
• Alternative Presentation: bilious vomiting, abdominal distension, tenderness, and a palpable mass
  • Vomiting seen in 50% of cases
• Shock and peritonitis if perforated

Imaging

• Should not delay surgical consult
• AXR
  • Sigmoid volvulus
    • Distended loop of colon without haustral markings
  • Cecal volvulus
    • May see findings similar to small bowel obstruction
      • Air-fluid level, paucity of gas
    • Classically see "coffee bean sign", large, distended colon with gas that seems to be bent over itself, making coffee bean shape
    • Can also perform contrast enema, look for "bird beak" sign
• CT
  • Highly sensitive and specific for volvulus
  • Usually not necessary in cecal volvulus
  • May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign"

DDx

1. Intussusception
2. Duodenal stenosis/atresia
3. Bowel perforation
4. Sepsis

Treatment

• Immediate surgical consultation
• Aggressive resuscitation
• Antibiotics if gangrenous bowel is suspected
• Sigmoid volvulus may be managed non-operatively by endoscopic detorsion
  • Successful in 50-90% of cases
  • Contraindicated if perforation or gangrenous bowel suspected
• All cases of cecal volvulus should be managed operatively

See Also

• Abdominal Pain (Peds)
• Volvulus (Adults)

Source

Tintinalli