Volvulus (peds)

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Background

  • can occur any time but 75% of cases in 1st month of life, d/t Ladd's bands lead to rotation.


Diagnosis

  • S/S: sudden onset vomiting, 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 webs, duodenal stenosis, duodenal or ileal atresia, ileus (but bilious vomiting in a young infant IS THIS DZ UNTIL proven otherwise)


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)
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