Volvulus (peds): Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
No edit summary |
||
| Line 7: | Line 7: | ||
**1st year of life: 85% | **1st year of life: 85% | ||
==Clinical Features== | |||
*Classic Triad: [[Abdominal pain (peds)|abdominal pain]], increased abdominal distention, [[Constipation (peds)|constipation]] | |||
*Classic Triad: abdominal pain, increased abdominal distention, constipation | *Alternative Presentation: bilious [[Nausea and vomiting (peds)|vomiting]], abdominal distension, tenderness, and a palpable mass | ||
*Alternative Presentation: bilious vomiting, abdominal distension, tenderness, and a palpable mass | |||
**Vomiting seen in 50% of cases | **Vomiting seen in 50% of cases | ||
*Shock and peritonitis if perforated | *[[Shock]] and [[peritonitis]] if perforated | ||
==Differential Diagnosis== | |||
#Duodenal stenosis/atresia | |||
#Bowel perforation | |||
#Sepsis | |||
{{Pediatric abdominal pain DDX}} | |||
==Diagnosis== | |||
===Imaging=== | ===Imaging=== | ||
*Should not delay surgical consult | *Should not delay surgical consult | ||
| Line 36: | Line 43: | ||
**Usually not necessary in cecal volvulus | **Usually not necessary in cecal volvulus | ||
**May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign" | **May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign" | ||
==Management== | ==Management== | ||
Revision as of 10:45, 21 January 2016
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%
Clinical Features
- 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
Differential Diagnosis
- Duodenal stenosis/atresia
- Bowel perforation
- Sepsis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Diagnosis
Imaging
- Should not delay surgical consult
- AXR
- Sigmoid volvulus
- 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
- Frimann Dahl's sign
- Absent rectal gass
- Cecal volvulus
- May see findings similar to small bowel obstruction
- Air-fluid level, paucity of gas
- Distended loop of colon with haustral markings
- May see findings similar to small bowel obstruction
- Malrotation with midgut volvulus
- Upper GI with contrast
- Obstructed duodenum with corkscrew appearance
- Misplaced duodenum as demonstrated by NG tube
- May see double-bubble sign due to obstruction
- US may show SMA compromise
- Upper GI with contrast
- Sigmoid volvulus
- 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"
Management
- NG tube decompression and laparotomy with Ladd procedure plus appendectomy
- Immediate surgical consultation
- Aggressive resuscitation
- Antibiotics if gangrenous bowel is suspected (triple coverage with ampicillin, gentamicin, metronidazole)
- 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