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Colonic Volvulus Associated with Hirschsprung's Disease in the Pediatric Age
Hazem Samir Amra1, Mostafa M Elghandour2, Mohammed Abdel-Latif3
1Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Hazem_samir@med.asu.edu.eg.
Purpose:
Colonic volvulus (CV) is a twist of part of the colon over its mesentery. Although CV is rare in children, its incidence is unknown. Hirschsprung's disease (HD) represents a significant risk factor of CV in children, especially when diagnosed late.
Aim:
To review the clinical, radiological and management data of children with CV associated with HD.
Methods:
Medical records were reviewed from January 2000 to December 2022 looking for children had CV associated with HD.
Results:
21 cases (17 males and 4 females) were admitted with CV. Their ages ranged from 8 days to 14 years. Sigmoid volvulus was recorded in 17 (81%) cases, while 4 (19%) cases had cecal volvulus. CV was associated with HD in 9 (42.9%) cases. Their median age was 7 years. Eight cases had sigmoid volvulus associated with short segment HD, while one case had cecal volvulus with long segment HD. CV was the first presentation, before the diagnosis of HD, in 8 cases. The diagnosis of HD was overlooked in 3 cases; 2 cases had an anastomotic leakage after sigmoidectomy, while the third case had recurrence of volvulus after successful nonoperative management.
Conclusion:
The diagnosis of CV in children mandates a high index of suspicion. Moreover, HD should be suspected and excluded in every case of CV in children.
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