Volvulus - childhoodChildhood 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.
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.
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
- 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
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.
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 fatal, depending on how much of the bowel is dead.
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.
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.
Deveney K. The management of colonic volvulus. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:187-190.
Peterson MA. Disorders of the large intestine. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 95.