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Splenic flexure volvulus in a child with chronic idiopathic intestinal pseudo-obstruction syndrome

Akinori Osuka1, Ryoichi Ikegami, Yoshio Watanabe

  • 1Department of Pediatric Surgery, Aichi Children's Health and Medical Center, 1-2 Osakada, Morioka-cho, Obu-city, Aichi 474-0031, Japan. a_osuka@sannet.ne.jp

Pediatric Surgery International
|July 13, 2006
PubMed

Insights

Splenic flexure volvulus is a rare condition in children, especially those with chronic idiopathic intestinal pseudo-obstruction syndrome. This case details successful management using cecal antegrade continence enema and subsequent surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Colorectal Surgery

Background:

  • Chronic idiopathic intestinal pseudo-obstruction syndrome (CIIPS) is a rare motility disorder.
  • Splenic flexure volvulus is an uncommon cause of intestinal obstruction, particularly in pediatric patients.
  • The combination of CIIPS and splenic flexure volvulus presents a unique clinical challenge.

Observation:

  • A 7-year-old girl with a history of CIIPS presented with symptoms suggestive of splenic flexure volvulus.
  • Initial management involved non-operative detorsion of the volvulus using a cecal antegrade continence enema (CACE).
  • Recurrent episodes of volvulus occurred over a 4-month period post-detorsion.

Findings:

  • The splenic flexure volvulus was successfully reduced via CACE, relieving the acute obstruction.
  • Due to recurrent episodes, an elective surgical resection of the splenic flexure with primary anastomosis was performed.
  • The patient experienced an uneventful recovery following the surgical intervention.

Implications:

  • This case highlights CACE as a potential non-operative management strategy for splenic flexure volvulus in select pediatric cases.
  • Surgical intervention may be necessary for definitive treatment in patients with recurrent volvulus or underlying conditions like CIIPS.
  • Understanding the pathogenesis and optimizing therapeutic measures are crucial for managing this rare condition in children.

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