Colonic Volvulus in Children With Intestinal Motility Disorders

Altaf, Muhammad A.; Werlin, Steven L.; Sato, Thomas T.; Rudolph, Colin D.; Sood, Manu R.

doi:10.1097/mpg.0b013e3181879eb5

Cited by 21 publications

(7 citation statements)

References 18 publications

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“…[2][3][4] The same predisposing factors in adults are reported in children, namely a dilated and redundant colon, previous abdominal surgery and abnormal peritoneal/mesenteric fixation. 4 Ascertaining whether CIPO independently contributed to the formation of caecal volvulus in this patient is not possible. Many predisposing factors are associated with the development of caecal volvulus and, as a result, it is impossible to differentiate whether a single factor acted alone or in combination.…”

Section: Discussionmentioning

confidence: 87%

Caecal volvulus in a patient with chronic intestinal pseudo-obstruction

Tatterton

El-Khatib

2011

annals

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Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder characterised by recurrent symptoms and signs of intestinal obstruction without an underlying mechanical cause. Caecal volvulus remains a rare cause of intestinal obstruction that often requires operative intervention. We describe the previously unreported case of caecal volvulus occurring in an adult patient with CIPO, together with his subsequent management. case historyA 49-year-old man presented with a history of bloating, constipation, abdominal pain and intermittent vomiting since late childhood. This had been extensively investigated in the past with plain radiography, barium studies, computed tomography (CT), ultrasonography and numerous blood studies. Multiple plain abdominal x-rays had invariably demonstrated dilated loops of bowel with multiple fluid levels. Transit studies revealed extremely poor intestinal transit times with a lack of peristaltic activity. In 1991 a small bowel meal demonstrated dilatation of the second and third parts of the duodenum with barium remaining in the duodenum at 24 hours. Due to ongoing and debilitating symptoms, the patient underwent a partial duodenectomy with duodenojejunostomy. The procedure offered only temporary relief of symptoms and so he was referred for specialist assessment, being eventually diagnosed with CIPO in 1992. The previous year, he had been diagnosed with an atonic bladder by a consultant urologist and instructed to perform daily intermittent self-catheterisation.Over the next 17 years, the patient had multiple admissions to the same institution with symptoms and signs of bowel obstruction. In these cases, he was treated conservatively with laxatives, prokinetic drugs, nasogastric aspiration and enteral/parenteral nutrition. In most cases he was under the care of the same consultant who recognised his condition and symptoms as 'functional' as opposed to 'mechanical'. In one recent admission, the patient presented with a two-day history of vomiting, absolute constipation, abdominal distension and left-sided abdominal pain. On examination the patient was clearly malnourished with a distended, non-tender abdomen. Bowel sounds were absent. A digital rectal examination was normal. An abdominal x-ray demonstrated a massively dilated loop of large bowel, suggestive of a colonic volvulus (Fig 1). CT of the abdomen was performed, demonstrating a large caecal volvulus (Fig 2).

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Section: Discussionmentioning

confidence: 87%

Caecal volvulus in a patient with chronic intestinal pseudo-obstruction

Tatterton

El-Khatib

2011

annals

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“…In one of the reported cases, severe constipation had required treatment with antegrade continence enemas via a Chait percutaneous cecostomy catheter. Severe constipation is also a known risk factor for developing a sigmoid volvulus (Altaf et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Fatal gastrointestinal complications in Pitt‐Hopkins syndrome

Koppen

Menke

Westra

et al. 2022

American J of Med Genetics Pt A

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Pitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder caused by mutations of the transcription factor 4 (Tcf4) gene. Individuals with PTHS often suffer from severe abdominal bloating and constipation. In this short communication, we discuss two individuals with PTHS who died unexpectedly due to gastrointestinal complications. We aim to increase awareness among healthcare professionals who care for individuals with PTHS, to ensure adequate screening and management of gastrointestinal symptoms in this population. Moreover, we discuss how fatal gastrointestinal complications may be related to PTHS and provide an overview of the literature.

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“…Sigmoid volvulus is the third most common cause of large intestinal obstruction in adults; however, it is very rare in children 3,[5][6][7][8][9][10][11] . There are few cases of sigmoid volvulus reported in children in the literature.…”

Section: Discussionmentioning

confidence: 99%

Chronic Constipation Leading to Sigmoid Colon Volvulus in an Adolescent

Alhindi¹,

Shihadeh²

2017

BMB

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60Constipation is very common in children 1,2 . The estimated prevalence of functional constipation in children is 4% to 36% 1,2 . The complaint of constipation accounts for 3% of children visits to primary physicians and 25% of visits to pediatric gastroenterologist 1,2 . In spite of its prevalence, it rarely causes serious complications in children, such as sigmoid colon volvulus 3 . The volvulus of the sigmoid colon is believed to be caused by a twist of the mesentery of the redundant colon 3 . An abdominal radiograph is helpful in diagnosing the presence of sigmoid volvulus. There are a few specific radiographic signs for sigmoid volvulus, including the dilated ahaustral loops. Rectal tube reduction is very successful in reducing sigmoid volvulus; however, ultimately, most patients require sigmoidectomy 4,5 .The aim of this report is to present a rare case of sigmoid volvulus in a young female due to chronic constipation. THE CASEThe patient was a healthy thirteen-year-old female adolescent, who had a long history of chronic constipation and was occasionally using laxatives. As a newborn, she did not have delayed passage of meconium. She presented to the emergency room with a three-day history of severe abdominal pain, abdominal distension and bilious vomiting. On examination, her abdomen was distended and tender. Rectal examination revealed an empty rectum. The total white blood cell (WBC) count was slightly elevated at 10,000 with 75% polymorphonucleocytes. The abdominal X-ray revealed a severely dilated sigmoid colon suggestive of volvulus. The patient had a contrast enema study, which revealed a cut-off point of obstruction at the sigmoid colon, see figures 1 (A and B). The volvulus was reduced via a rectal tube. Subsequently, she had an elective sigmoidectomy and primary re-anastomosis. The rectal biopsy did not show evidence of Hirschsprung's disease. The patient was discharged in good general condition on the seventh postoperative day.We report a case of one of the rare complications of constipation in an adolescent. The patient presented with acute abdominal symptoms and the radiographic images revealed a dilated twisted sigmoid colon. Rectal tube reduction was successful and subsequently, the patient underwent sigmoidectomy and uneventful recovery.

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Colonic Volvulus in Children With Intestinal Motility Disorders

Abstract: Clinicians should be vigilant and include volvulus in the differential diagnosis of the acute onset of abdominal distension and pain in patients with CIP and CIC. Delay in diagnosis can result in bowel ischemia and perforation.

Cited by 21 publications

References 18 publications

Caecal volvulus in a patient with chronic intestinal pseudo-obstruction

Caecal volvulus in a patient with chronic intestinal pseudo-obstruction

Fatal gastrointestinal complications in Pitt‐Hopkins syndrome

Chronic Constipation Leading to Sigmoid Colon Volvulus in an Adolescent

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