[Video-assisted sigmoidectomy as an option for Sigmoid volvulus management in the pediatric population]

The aim of the present study was to evaluate clinical presentation and management of sigmoid volvulus in children. Sigmoid volvulus is one of the three leading causes of acute obstruction of the colon and is between 50 and 90% of all large bowel volvulus. In the pediatric population only 3 to 5% of bowel obstructions are caused by volvulus and there are less than 100 cases reported in the literature. The presence of a redundant sigmoid with a narrow mesentery (dolicosigmoide) is a prerequisite for the volvulus formation. The etiology in the pediatric population is considered secondary to the presence of a broad meso with a narrow base associated with abnormal fixation colon. Other factors include history of anorectal malformation, Prune Belly syndrome, intestinal malrotation and Hirschsprung disease. Initial management followed by endoscopic minimally invasive sigmoidectomy has proven safe and effective.

This paper presents the experience of 4 patients between 9 and 14 managed in our department in 2013, with a diagnosis of volvulus of the sigmoid, which were initially taken to a first surgical endoscopic decompression of volvulus and a second half were carried sigmoid which took place in a video-assisted. In this series, no intraoperative complications were documented and monitoring more than six months only one patient has required new interventions, in a special case because the patient has associated myopathy; inflammatory leiomioscitis, which predisposes to episodes of intestinal obstruction.

We believe that endoscopic detorsion followed by an early video-assisted sigmoid is the ideal technique for the management of these patients.