Volvulus (peds): Difference between revisions

Revision as of 21:08, 2 February 2015

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%

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

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
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"

NG tube decompression and laparotomy
- 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

Tintinalli
Murphy MS. Management of bloody diarrhoea in children in primary care. BMJ. May 3 2008;336(7651):1010-5.

Authors:

@@ Line 31: / Line 31: @@
 **May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign"
-==DDx==
+==Differential Diagnosis==
-#Intussusception
-#Necrotizing enterocolitis
 #Duodenal stenosis/atresia
 #Bowel perforation
 #Sepsis
+{{Pediatric abdominal pain DDX}}
 ==Treatment==