Endoscopic management of sigmoid volvulus in children

Abstract

Sigmoid volvulus (SV) is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop, avoiding further complications such as necrosis, perforation and sepsis. In patients with no evidence of peritonitis or ischemic bowel, treatment starts with resuscitation and detorsion of the SV, accomplished by means of sigmoidoscopy and concomitant rectal tube placement. The bowel is then prepared and surgery is undertaken electively during the same hospitalization. We report a detailed review of the literature focusing on technical details, risks and benefits of endoscopic management of SV in childhood.

Sigmoid Volvulus in Children: Diagnosis and Therapeutic Challenge

“…Nevertheless, it is believed by some to have a higher complication rate (perforation due to bowel ischemia), and sometimes more than one attempt is necessary [1,4]. As for endoscopic reduction, previous reports have stated a lower success rate in children [1,2,7], but a recent review of the literature report- ed a success rate of 69% and no associated complications, also having the advantage that it allows for inspection of the bowel mucosa and avoiding exposure to radiation [6]. The main complications associated with this procedures are iatrogenic bowel perforation and unsuccessful detorsion.…”

“…Different studies found an incidence of Hirschsprung disease in up to 18% of patients with sigmoid volvulus [4,6]. There are also reports that identified roundworm infestation [6,7], malrotation [1], and neurologic disorders [2,6] as predisposing factors.…”

“…In pediatrics, it is most often associated with congenital anomalies of the fixation of the colon (a redundant sigmoid colon with a short mesenteric axis), a longstanding history of constipation, or Hirschsprung disease [1,[3][4][5][6]. Different studies found an incidence of Hirschsprung disease in up to 18% of patients with sigmoid volvulus [4,6].…”

“…Most authors agree that if a patient is stable and there are no signs of bowel perforation or necrosis, a nonoperative reduction must be attempted [2,9]. The importance of these procedures is that they reduce the higher complication rate associated with a colectomy in an emergency setting [2,6]. The main controversy is about whether it should be endoscopic or a contrast enema reduction.…”

“…In order to reduce this complication, the following points are important: (1) a thorough selection of patients and the reduction technique, (2) avoidance of excessive air insufflation, and (3) the use of flexible scopes. Rigid devices should not be used, because of higher perforation rates [6]. Patients that are clinically unstable or have a suspected bowel perforation, bowel necrosis, or peritonitis are contraindicated for endoscopic/nonsurgical reduction.…”