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Volvulus - childhood

Childhood 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

 

  • 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 so severe that an infant is taken to the emergency room. Early treatment 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

 

In some cases, colonoscopy can be used to correct the problem. A colonoscopy uses 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 (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 will become very ill. Get medical attention right away if this happens.

 

 

References

Peterson MA. Disorders of the large intestine. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 95.

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          Review Date: 8/11/2014

          Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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