Volvulus (peds): Difference between revisions
| Line 31: | Line 31: | ||
==Treatment== | ==Treatment== | ||
*Immediate surgical consultation | *Immediate surgical consultation | ||
*Aggressive resuscitation | *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 | |||
==Source== | ==Source== | ||
Revision as of 16:47, 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 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
- May see findings similar to small bowel obstruction
- Sigmoid volvulus
DDx
- Intussusception
- Duodenal stenosis/atresia
- Bowel perforation
- 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
Source
Tintinalli