Volvulus (peds): Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Clinical Presentation=== | ===Clinical Presentation=== | ||
* | *Classic Triad: | ||
* | **Inc abdominal distention | ||
*Shock and peritonitis | **Constipation | ||
**Abdominal pain | |||
*Vomiting seen in 50% of cases | |||
*Shock and peritonitis if perforated | |||
===Imaging=== | ===Imaging=== | ||
*Should not delay surgical consult | *Should not delay surgical consult | ||
*AXR | *AXR | ||
** | **Sigmoid volvulus | ||
** | ***Distended loop of colon with haustral markings | ||
***Air-fluid level, paucity of gas | **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 | |||
==DDx== | ==DDx== | ||
Revision as of 16:35, 28 October 2011
Background
- 2 types: Sigmoid and cecal volvulus
- Surgical emergency
- Can occur at any time
- 50% of cases occur in 1st mo of life, 90% w/in 1st yr
Diagnosis
Clinical Presentation
- Classic Triad:
- Inc abdominal distention
- Constipation
- Abdominal pain
- Vomiting seen in 50% of cases
- Shock and peritonitis if perforated
Imaging
- Should not delay surgical consult
- AXR
- Sigmoid volvulus
- Distended loop of colon with 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
- May see findings similar to small bowel obstruction
- Sigmoid volvulus
DDx
- Intussusception
- Duodenal stenosis/atresia
- Bowel perforation
- Sepsis
Treatment
- Immediate surgical consultation
- Aggressive resuscitation
Source
Tintinalli