Volvulus (peds)

This page is for pediatric patients. For adult patients, see: volvulus.

Background

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%

Classic Triad: abdominal pain, increased abdominal distention, constipation
Alternative Presentation: bilious vomiting, abdominal distension, tenderness, and a palpable mass
- Vomiting seen in 50% of cases
Shock and peritonitis if perforated

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 gas
- 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

This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.