A volvulus, which in this case occurs during childhood, is a twisting of the bowel with obstruction of the flow of material through the bowel, variable loss of blood supply and possible tissue death.
Causes, incidence, and risk factors
A volvulus is a condition in which the bowel becomes twisted. This twisting causes obstruction of the intestine, and also often cuts off the blood supply to the intestine. This can cause death of some or all of the intestine, which is often fatal.
Malrotation of the bowel during fetal development may predispose infants to a volvulus, although a volvulus can occur in the absence of malrotation. Volvulus associated with malrotation often occurs early in life, frequently in the first year.
Infants develop sudden onset signs of bowel obstruction that may include nausea and vomiting, bloody stools, abdominal pain, constipation, and shock. Symptoms are generally dramatic enough that infants are taken early to the emergency room, which can be critical for survival.
- Abdominal tenderness
- Nausea or vomiting
- Vomiting green bile-looking material
- Bloody or dark red stool
- Constipation or difficulty expelling stools
- Distended abdomen
Signs and tests
- A stool guaiac is positive for blood in the stool.
- An upper GI X-ray with small bowel follow-through shows a malrotated bowel or midgut volvulus.
- A CT scan may show evidence of intestinal obstruction.
- A barium enema often shows an abnormal position of the bowel, suggesting malrotation.
- Blood tests to check the electrolytes may show abnormalities.
Emergency surgery to repair the volvulus is necessary. An incision is made in the abdomen, the bowels are inspected, and the volvulus is reduced. This means that the bowels are untwisted and their blood supply restored.
If a small segment of bowel is necrotic (dead from lack of blood flow), it is removed and the ends of the bowels sewn back together, or used to form a colostomy or ileostomy (tube to the outside through which bowel contents can be removed; the term depends on where the tube is formed). If the entire bowel is necrotic, this can be fatal and the outlook is poor.
Early recognition of the volvulus and prompt treatment generally results in a good outcome. If necrosis of the bowel occurs, depending on how much bowel is necrotic, the prognosis is often poor.
- Secondary peritonitis
- Short bowel syndrome (after removal of a large part of the small bowel)
Calling your health care provider
This is an emergency condition! The symptoms of childhood volvulus develop rapidly and the child becomes severely ill.
by Simon D. Mitin, M.D.