Sigmoid Volvulus in Children: Diagnosis and Therapeutic Challenge

Abstract

Background: Sigmoid volvulus is a rare condition in children. Early diagnosis increases the success of nonsurgical treatment in the emergency department, but posterior elective surgery is important due to the risk of recurrence. Methods/Conclusions: We present the case of a healthy 16-yearold girl with recurrent volvulus and successful endoscopic treatment followed by elective surgery. ResumoIntrodução: A ocorrência de um vólvulo do sigmoide na criança é raro, constituindo desta forma um desafio diagnóstico. A identificação precoce desta patologia é essencial pois permite que a redução do vólvulo seja efetuada numa primeira abordagem por métodos não cirúrgicos, e quanto mais precoce na história da doença maior a taxa de sucesso e menor o risco de complicações associadas. Métodos/Conclusões: No entanto a cirurgia eletiva posterior é mandatória pelo alto risco de recidiva. Os autores apresentam o caso de uma adolescente sem antecedentes patológicos de relevo com um vólvulo sigmoideu recorrente submetido a redução endoscópica com sucesso.

Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?

“…Colonic volvulus, mainly from the sigmoid colon, remains an important cause of emergency admissions, particularly in the elderly (although it can also occur in children [17]) and in patients with multiple comorbidities [3,5,16]. In our series, besides advanced age (median age 83 years), all of the patients had at least one condition reported as a risk factor for SV.…”

Sigmoid volvulus in a teenager, successfully managed with endoscopic detorsion: An unusual case report and review of the literature

“…It is more common in males and occurs in ratios ranging from 2:1 to 10:1. Although volvulus in adults is common in Asian populations, in pediatric surgical practice volvulus of the sigmoid colon remains a rare occurrence and only a few isolated case reports and case series have been reported [ 1 , 10 ]. Salas et al [ 3 ] has stated the median age at presentation 7 years, ranging from 4 h to 18 years in pediatric sigmoid volvulus and boys-to-girls ratio being 3.5 to 1 however, Slidell et al reported three teenagers ages 17–19 with sigmoid volvulus [ 11 ] and T.R.…”

“…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. The importance of these procedures is that they reduce the higher complication rate associated with a colectomy in an emergency setting [ 1 ]. Early endoscopic detorsion and decompression allow direct visualization of the vascular compromise, assessment of bandwidth of the volvulus, can reduce complications and mortality, and has a success rate of 33% to 91%.…”

“…Sigmoid volvulus occurs due to torsion of a dilated sigmoid colon around its mesenteric axis. This causes venous and arterial blood flow obstruction with progressive bowel ischemia, necrosis, and perforation if left untreated [ 1 ]. It is rare in children but should be considered in the differential diagnosis in an adolescent who presents with acute abdomen in a background of chronic constipation [ 2 , 3 ].…”

“…Endoscopic detorsion is the initial treatment of choice in sigmoid volvulus in the absence of complications [ 3 , 5 , 6 ]. However, due to the risk of recurrence, the definite treatment in children consists of sigmoid resection and primary anastomosis [ 1 ]. The author presents here a case of sigmoid volvulus in a 19-year-old male, managed with successful endoscopic detorsion followed by elective surgery.…”