Volvulus - childhood
Definition
A volvulus is a twisting of the intestine that can occur in childhood. It causes a blockage, and may cut off blood flow and damage part of the intestine.
Alternative Names
Childhood volvulusCauses
A birth defect called intestinal malrotation can make infants more likely to develop a volvulus. However, a volvulus can occur without malrotation.
Volvulus due to malrotation often occurs early in life, usually in the first year.
Symptoms
- 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 usually severe enough that infants are taken early to the emergency room, which can be critical for survival.
Exams and Tests
- Barium enema
- Blood tests to check electrolytes
- CT scan
- Stool guaiac (shows blood in the stool)
- Upper GI
Treatment
Emergency surgery is needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply 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 sewn back together. Or, they are used to form a connection of the intestines to the outside, through which bowel contents can be removed (colostomy or ileostomy).
Outlook (Prognosis)
Diagnosing and treating volvulus quickly generally leads to a good outcome.
If the bowel is dead (necrotic), the outlook is poor. The situation may be life-threatening, depending on how much of the bowel is dead.
Possible Complications
- 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 becomes severely ill. Get medical attention immediately.
References
Peterson MA. Large Intestine. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006:chap 94.
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
