Volvulus (peds): Difference between revisions

Revision as of 23:11, 22 June 2011

Background

Surgical emergency
Can occur at any time
- 50% of cases occur in 1st mo of life, 90% w/in 1st yr

Diagnosis

Clinical Presentation

Sudden-onset bilious vomiting
Abd pain (constant) & distention
Shock and peritonitis

Imaging

Should not delay surgical consult
AXR
- Loop of bowel overlying liver
- Evidence of obstruction
  - Air-fluid level, paucity of gas

DDx

Intussusception
Duodenal stenosis/atresia
Bowel perforation
Sepsis

Treatment

Immediate surgical consultation
Aggressive resuscitation

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Can occur at any time (though 50% of cases occur in 1st month of life)
+*Surgical emergency
+*Can occur at any time
+**50% of cases occur in 1st mo of life, 90% w/in 1st yr
 ==Diagnosis==
-*S/S
+===Clinical Presentation===
-**Sudden-onset, bilious vomiting (always consider a surgical emergency)
+*Sudden-onset bilious vomiting
-abd pain & feeding intol in an otherwise healthy infant, bilious vomiting in 77-100% of cases. Volume depletion, grunting resps, jaundice (33%), shock, diffuse abd tenderness, bloody stools (late).* In '93 Torres etal found 22 pts undergoing surgery for malrotation 50% had nl abd exams and 32% had distension but no tenderness.
+*Abd pain (constant) & distention
+*Shock and peritonitis
-* AXR* dilated stomach & duodenum w/o distal gas
+===Imaging===
-* can have nl xr.
+*Should not delay surgical consult
-* upper GI series shows narrowing at site of obstruction with corckscrewing around the SMA
+*AXR
-* Clockwise whirlpool sign using color doppler flow has a sensitivity 92%,spec 100%,PPV 100%
+**Loop of bowel overlying liver
+**Evidence of obstruction
+***Air-fluid level, paucity of gas
 ==DDx==
-#Duodenal web
+#Intussusception
-#Duodenal stenosis
+#Duodenal stenosis/atresia
-#Duodenal or ileal atresia
+#Bowel perforation
-#Ileus
+#Sepsis
 ==Treatment==
-*Supportive care w/ aggressive fluids, NGT, ABX (amp, gent, clinda)
+*Immediate surgical consultation
-*Stable pt can have UGI series to confirm Dx
+*Aggressive resuscitation
-*shock pt needs surgery asap "time is bowel" (6 hr before bowel is dead)
 ==Source==