Volvulus (peds)
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