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Sigmoid volvulus in childhood
S D Smith1, E S Golladay, C Wagner
1Department of Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock 72202.
Insights
Sigmoid volvulus is rare in children but can be serious. Nonoperative decompression is effective for elective sigmoid resection, which is the definitive treatment to prevent mortality.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Sigmoid volvulus, though common in adults, is an infrequent pediatric condition.
- This study investigates 48 pediatric cases of sigmoid volvulus, with a mean age of 8 years.
Observation:
- Common symptoms include abdominal pain (66%) and vomiting (31%).
- Abdominal distention (69%) was the most frequent finding.
- The classic 'omega sign' was noted on plain films in only 29% of cases.
Findings:
- Barium enema was diagnostic in 61% of pediatric sigmoid volvulus cases.
- Nonoperative treatment (barium enema or proctoscopy) succeeded in 17 patients, but had a 31% recurrence rate.
- Surgical 'derotation' alone had a 29% mortality, while immediate resection had a 25% mortality.
Implications:
- Elective sigmoid resection offers the best outcome, with no mortality in this series.
- Nonoperative decompression is recommended for elective resection in patients without peritonitis.
- Prompt diagnosis and appropriate management are crucial for improving outcomes in pediatric sigmoid volvulus.
Abstract:
Although it is common in the adult population, sigmoid volvulus is unusual in childhood. We report the cases of four children treated for sigmoid volvulus, and we review an additional 44 cases. The mean age of occurrence was 8 years. Predisposing factors were present in 33%. Abdominal pain (66%), vomiting (31%), and obstipation (10%) were the most common symptoms. Abdominal findings included distention (69%), tenderness (41%), and a mass (10%). The classic roentgenographic omega sign of volvulus was present on plain films in only 29% of the cases. Barium enema examination was diagnostic in 61% of the cases in which it was used. Nonoperative treatment by barium enema or proctoscopy was successful in all 17 cases in which it was attempted. The recurrence rate after nonoperative treatment was 31%. Thirty children had operation. The mortality in the group of patients having "derotation" alone was 29%. Immediate resection was associated with a 25% mortality; none of the patients who had elective resection died. Sigmoid resection is the definitive treatment for children as well as adults, but nonoperative decompression to allow for elective resection should be attempted in patients who have no evidence of peritonitis.