Volvulus (peds)

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  • 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%

Clinical Features

Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence



  • Should not delay surgical consult
  • Abdominal XR
    • 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
    • Malrotation with midgut volvulus
      • Upper GI with contrast
        • Obstructed duodenum with corkscrew appearance
        • Misplaced duodenum as demonstrated by NG tube
        • May see double-bubble sign due to obstruction
      • US may show SMA compromise
  • CT Abd/pelvis
    • Highly sensitive and specific for volvulus
    • Usually not necessary in cecal volvulus
    • May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign"


  • Emergent surgical consult
  • Place NG tube
  • Fluid resuscitation
  • Antibiotics if gangrenous bowel is suspected (triple coverage with ampicillin, gentamicin, metronidazole)
  • 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


  • Admit

See Also