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Diagnosis of pediatric colonic volvulus with abdominal radiography: how good are we?
Megan B Marine1,2, Matthew L Cooper3,4, Lisa R Delaney3,4
1Department of Radiology and Imaging Sciences, Riley Hospital for Children, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA. mbshelto@iupui.edu.
Insights
Diagnosing colonic volvulus in children using abdominal radiographs is challenging. Key findings like focal colonic loop distention or absent rectal gas can suggest this rare condition.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Surgery
Background:
- Colonic volvulus is a rare condition in pediatric patients, often linked to intestinal dysmotility.
- Diagnosing colonic volvulus in children via abdominal radiographs presents significant challenges.
Purpose of the Study:
- To evaluate the diagnostic accuracy of abdominal radiographs for colonic volvulus in children.
- To identify radiographic findings suggestive of colonic volvulus in pediatric cases.
Main Methods:
- Retrospective review of 19 pediatric colonic volvulus cases (2003-2014).
- Analysis of medical charts, clinical presentations, and original radiograph reports.
- Independent review of radiographs by two pediatric radiologists to assess findings and interobserver variability.
Main Results:
- 18 patients (11 males, mean age 14 years) had 19 cases; 89% had neurological impairment, 56% had intestinal dysmotility.
- Abdominal distension (74%) and pain (58%) were common presentations.
- Radiographs diagnosed colonic volvulus in only 44% of cases; focal colonic loop dilation (87%) and absent rectal gas (73.5%) were most frequent findings.
Conclusions:
- Colonic volvulus diagnosis in children is difficult using standard radiographic methods.
- Radiologists should consider colonic volvulus when observing focal colonic loop distention or absent rectal gas on radiographs.
Background:
Colonic volvulus is rare in children and associated with colonic dysmotility. Diagnosis of colonic volvulus on radiographs in these patients can be challenging. The purpose of the study was to identify the accuracy of abdominal radiographs and findings suggestive of colonic volvulus.
Materials And Methods:
A retrospective (2003- 2014) study of all children with colonic volvulus proven surgically or endoscopically reviewed their medical charts for underlying disease and clinical presentation as well as their original radiograph reports. Two pediatric radiologists (reader 1 and reader 2) independently reviewed the radiographs. The kappa test was used to evaluate interobserver variability.
Results:
There were 19 cases of colonic volvulus in 18 patients (11 males) a mean age 14 years. Cecal volvulus was the most common finding at 14/19 cases (74%). Sixteen of 18 (89%) patients had neurological impairment and 10 of 18 (56%) had intestinal dysmotility. The most common presentation was abdominal distension (14/19 [74%]) and pain (11/19 [58%]). Colonic volvulus was diagnosed in only 7/16 (44%) of the abdominal radiographs. The specific finding of a coffee-bean sign was retrospectively observed only by reader 2 in two cases. Absence of rectal gas and focal colonic loop dilation were the most common findings by the readers (average 73.5% and 87%, respectively) with Kappa values of 0.3 and 0.38, respectively.
Conclusion:
Diagnosis of colonic volvulus in children can be challenging. Radiologists should be alerted to the possibility of colonic volvulus when there is focal colonic loop distention or absent rectal gas.
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