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Volvulus - childhood

Childhood volvulus; Abdominal pain - volvulus

 

A volvulus is a twisting of the intestine that can occur in childhood. It causes a blockage that may cut off blood flow. Part of the intestine may be damaged as a result.

Causes

 

A birth defect called intestinal malrotation can make an infant more likely to develop a volvulus. However, a volvulus can occur without this condition present.

Volvulus due to malrotation occurs most often in the first year of life.

 

Symptoms

 

Common symptoms of volvulus are:

  • Bloody or dark red stools
  • Constipation or difficulty releasing stools
  • Distended abdomen
  • Pain or tenderness in the abdomen
  • Nausea or vomiting
  • Shock
  • Vomiting green material

Symptoms are very often severe. The infant in such cases is taken to the emergency room. Early treatment can be critical for survival.

 

Exams and Tests

 

Your health care provider may order the following tests to diagnose the condition:

  • Barium enema
  • Blood tests to check electrolytes
  • CT scan
  • Stool guaiac (shows blood in the stool)
  • Upper GI series

 

Treatment

 

In some cases, colonoscopy can be used to correct the problem. This involves use of a flexible tube with a light on the end that is passed into the colon (large bowel) through the rectum.

Emergency surgery is often needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply is restored.

If a small segment of bowel is dead from a lack of blood flow (necrotic), it is removed. The ends of the bowel are then sewn together. Or, they are used to form a connection of the intestines to the outside of the body (colostomy or ileostomy). Bowel contents can be removed through this opening.

 

Outlook (Prognosis)

 

Most of the time, prompt diagnosis and treatment of volvulus leads to a good outcome.

If the bowel is dead, the outlook is poor. The situation may be fatal, depending on how much of the bowel is dead.

 

Possible Complications

 

Possible complications of volvulus are:

  • Secondary peritonitis
  • Short bowel syndrome (after removal of a large part of the small bowel)

 

When to Contact a Medical Professional

 

This is an emergency condition. The symptoms of childhood volvulus develop quickly and the child will become very ill. Get medical attention right away if this happens.

 

 

References

Bales C, Liacouras CA. Intestinal atresia, stenosis, and malrotation. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 330.

Herline A, Geiger TM. The management of colonic volvulus. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:191-193.

Peterson MA, Wu AW. Disorders of the large intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 85.

Turay F, Rudolph JA. Nutrition and gastroenterology. In: Zitelli BJ, McIntire SC, Norwalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 11.

Text only

 
  • Volvulus

    Volvulus - illustration

    An intestinal obstruction is a partial or complete blockage that results in the failure of the intestinal contents to pass through the bowel. A volvulus is a twisting of the bowel on itself. It is one cause of intestinal obstruction.

    Volvulus

    illustration

  • Volvulus - X-ray

    Volvulus - X-ray - illustration

    A GI series in a patient with a twisted bowel (volvulus).

    Volvulus - X-ray

    illustration

    • Volvulus

      Volvulus - illustration

      An intestinal obstruction is a partial or complete blockage that results in the failure of the intestinal contents to pass through the bowel. A volvulus is a twisting of the bowel on itself. It is one cause of intestinal obstruction.

      Volvulus

      illustration

    • Volvulus - X-ray

      Volvulus - X-ray - illustration

      A GI series in a patient with a twisted bowel (volvulus).

      Volvulus - X-ray

      illustration

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          Review Date: 6/21/2018

          Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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