Volvulus-Child

  • Definition

    A volvulus occurs when part of the large intestine is twisted on itself and the mesentery. The mesentery is a supportive tissue that anchors the intestines to the back wall of the abdomen. The twisted intestine creates a bowel obstruction that cuts off the blood supply and affects bowel function.
    A volvulus requires immediate medical attention.
  • Causes

    It is not known what causes the twisting to happen. Rarely, this may lead to bowel obstruction.
  • Risk Factors

    Factors that increase your child’s chance of volvulus include:
    • Congenital defects including:
      • Elongated or enlarged colon
      • Congenital intestinal malrotation
      • Sigmoid colon unattached to abdominal wall
      • Narrow mesenteric connection to the colon
    • Irregular bowel habits
    • Chronic constipation
    • High fiber diet
    • Previous volvulus
    • Hirschsprung disease
  • Symptoms

    In some cases, your child may not have symptoms. In those that have them, symptoms may include:
  • Diagnosis

    Your child’s doctor will ask you about symptoms and medical history. A physical exam will be done. Your child’s doctor may recommend:
    • Blood tests for electrolytes
    • Hematest to check for hidden blood in the stool
    Imaging tests will be needed to see your child’s internal structures. Tests include:
  • Treatment

    The treatment goal is to unblock the obstruction and restore bowel function. Treatment may include:
    Hydration
    IV fluids may be given to prevent dehydration and shock. Your child may need a nasogastric tube to help prevent the build-up of gas in the stomach. A nasogastric tube is a tube inserted through the nose, down the esophagus, and into the stomach.
    Medications
    Your child’s doctor may recommend antibiotics if an infection is present or possible. It is important for your child to take all of the antibiotics as recommended, even when feeling well.
    Surgery
    Your child’s doctor will untwist the intestine and assess for any damage. In most cases, untwisting the intestine helps restore blood flow and bowel function.
    If needed, the section of intestine that is damaged is removed. The two remaining healthy ends are put together with stitches or staples. This procedure may reduce the chance of another volvulus.
  • Prevention

    There are no current guidelines to prevent volvulus.
  • RESOURCES

    American Academy of Pediatrics http://healthychildren.org

    American Gastroenterological Society http://www.gastro.org

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology http://www.cag-acg.org

    Canadian Paediatric Society http://cps.ca

    References

    Antatomic problems of the lower GI tract. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/anatomiccolon/index.aspx. Updated December 28, 2012. Accessed June 14, 2013.

    Intestinal malrotation and volvulus. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/i/intestinal-malrotation. Updated August 2010. Accessed June 14, 2013.

    Intestinal obstruction and volvulus. PEMSoft at EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed June 14, 2013.

    Lal SK, Morgenstern R, et al. Sigmoid volvulus an update. Gastrointest Endosc Clin N Am. 2006;16(1):175-87.

    Osiro SB, Cunningham D, et al. The twisted colon: a review of sigmoid volvulus. Am Surg. 2012;78(3):271-9.

    Sigmoid volvulus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 21, 2010. Accessed June 14, 2013.

    Williams H. Green for danger! Intestinal malrotation and volvulus. Arch Dis Child Educ Prac Ed. 2007;92(3):ep87-ep91.

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