Large bowel volvulus in children. Review of a case material and the literature
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Diagnosing large bowel volvulus in children can be challenging due to vague symptoms and inconclusive imaging. Prompt radiological evaluation, including barium enemas, is crucial for accurate diagnosis and determining appropriate treatment, which may include non-operative management.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Surgical Pediatrics
Background:
- Volvulus of the colon, including the right and sigmoid colon, is a rare but serious condition in pediatric patients.
- Clinical presentation often involves non-specific symptoms such as abdominal pain, making diagnosis difficult.
- Plain film radiography can be equivocal in diagnosing large bowel volvulus.
Purpose of the Study:
- To report on pediatric cases of right and sigmoid colon volvulus.
- To evaluate the diagnostic utility of radiological imaging, including plain films and barium enemas.
- To discuss treatment approaches for pediatric large bowel volvulus.
Main Methods:
- Retrospective review of seven pediatric patients diagnosed with colon volvulus.
- Analysis of clinical manifestations and radiological findings (plain films and barium enemas).
- Evaluation of treatment outcomes for both operative and non-operative management.
Main Results:
- Seven pediatric patients presented with right (n=4) or sigmoid (n=3) colon volvulus.
- Clinical symptoms were generally vague, primarily abdominal pain.
- Radiological findings on plain films were often inconclusive, but supplementary barium enemas aided in diagnosis.
- Non-operative management and spontaneous reduction were observed as potential treatment outcomes.
Conclusions:
- An aggressive radiological approach, including barium enema, is essential for diagnosing pediatric large bowel volvulus when plain films are inconclusive.
- Non-operative management may be as effective as elective surgery for viable bowel.
- Spontaneous resolution of volvulus can lead to a permanent cure.
Abstract:
Four pediatric patients with volvulus of the right colon, and three others with twisting of the sigmoid colon are reported. The clinical manifestations, mainly pain, were vague. Radiological plain film findings were occasionally characteristic, but were in the majority of cases equivocal. An active radiological approach including a supplementary barium enema in any patient with inconclusive plain abdominal roentgenograms will, in addition to other unexpected diagnoses, reveal rare cases of large bowel volvulus. Elective surgical procedures, carried out on viable bowel do not necessarily provide advantages over a non-operative approach. In addition spontaneous reduction of the volvulus may result in permanent cure.