Volvulus (peds): Difference between revisions
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==Background== | ==Background== | ||
*Can occur at any time (though 50% of cases occur in 1st month of life) | |||
* | |||
==Diagnosis== | ==Diagnosis== | ||
*S/S | |||
**Sudden-onset, bilious vomiting (always consider a surgical emergency) | |||
* S/S | 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. | ||
* AXR* dilated stomach & duodenum w/o distal gas | * AXR* dilated stomach & duodenum w/o distal gas | ||
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==DDx== | ==DDx== | ||
#Duodenal web | |||
#Duodenal stenosis | |||
#Duodenal or ileal atresia | |||
#Ileus | |||
==Treatment== | ==Treatment== | ||
*Supportive care w/ aggressive fluids, NGT, ABX (amp, gent, clinda) | |||
*Stable pt can have UGI series to confirm Dx | |||
*shock pt needs surgery asap "time is bowel" (6 hr before bowel is dead) | |||
==Source== | |||
Tintinalli | |||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 22:26, 13 June 2011
Background
- Can occur at any time (though 50% of cases occur in 1st month of life)
Diagnosis
- S/S
- Sudden-onset, bilious vomiting (always consider a surgical emergency)
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.
- AXR* dilated stomach & duodenum w/o distal gas
- can have nl xr.
- upper GI series shows narrowing at site of obstruction with corckscrewing around the SMA
- Clockwise whirlpool sign using color doppler flow has a sensitivity 92%,spec 100%,PPV 100%
DDx
- Duodenal web
- Duodenal stenosis
- Duodenal or ileal atresia
- Ileus
Treatment
- Supportive care w/ aggressive fluids, NGT, ABX (amp, gent, clinda)
- Stable pt can have UGI series to confirm Dx
- shock pt needs surgery asap "time is bowel" (6 hr before bowel is dead)
Source
Tintinalli