Volvulus (peds)

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

DDx

1. Intussusception
2. Duodenal stenosis/atresia
3. Bowel perforation
4. Sepsis

Treatment

• Immediate surgical consultation
• Aggressive resuscitation

Source

Tintinalli