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Pediatric Sigmoid Volvulus
1From the Harbor UCLA Medical Center, 1000 W. Carson St, Building D-9 Box 21, Torrance, CA.
Insights
Sigmoid volvulus (SV) is a rare cause of abdominal pain in children, presenting with obstruction and ischemia. Early diagnosis and treatment, including sigmoidoscopy and potential surgery, are crucial to prevent severe complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Sigmoid volvulus (SV) is uncommon in children, typically affecting older adults.
- SV involves the twisting of the sigmoid colon around its mesentery, leading to bowel obstruction and ischemia.
Observation:
- Pediatric patients with SV commonly exhibit abdominal pain, nausea, and distension.
- Symptoms can manifest acutely or chronically, often with a history of constipation or intermittent distension.
Findings:
- Initial management includes endoscopic reduction of the volvulus and rectal biopsy to exclude Hirschsprung disease.
- Surgical intervention is indicated for recurrent cases or confirmed Hirschsprung disease.
Implications:
- Prompt recognition of SV in children is vital due to the risk of significant morbidity and mortality.
- Consideration of SV in pediatric abdominal pain presentations can prevent diagnostic delays and improve outcomes.
Abstract:
Sigmoid volvulus is an extremely rare cause of abdominal pain in children. More commonly seen in older adults, an SV occurs when a redundant loop of sigmoid wraps around its elongated, narrow mesentery causing obstruction and ischemia to the affected bowel segment. Children usually present with abdominal pain, nausea, and abdominal distension. Presentations may be acute or chronic with a history of episodic constipation or abdominal distension. The treatment plan includes an initial reduction of the volvulus via sigmoidoscopy with rectal biopsy to rule out Hirschsprung disease; however, operative management to remove the dilated sigmoid colon may be required in the setting of recurrence or confirmed Hirschsprung disease. Although rare, SV should be considered in a child presenting with abdominal pain as a missed diagnosis can have high potential morbidity and mortality.
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