Colonoscopic decompression of childhood sigmoid and cecal volvulus

Abstract

Cases of colonic volvulus in children are infrequently described in the literature. Here we describe the case of three patients with colonic volvulus. The first patient was a 10-year-old girl with abdominal dilation and pain and no bowel movement for 48 h. Her abdominal X-ray showed the coffee bean sign adjacent to the diaphragm, which was compatible with a diagnosis of cecal volvulus. The second patient was a 4-year-old boy with a history of chronic constipation during the past year and with no bowel movement for 24 h. Clinical manifestations included severe nausea, vomiting, and abdominal distension. His abdominal X-ray demonstrated the coffee bean sign in the right upper quadrant with upward convexity corresponding to a diagnosis of sigmoid volvulus. The third patient was a 10-month-old male who presented with excessive crying, malnutrition, and no bowel movement for 36 h. His abdominal X-ray demonstrated the coffee bean sign in the left upper quadrant with upward convexity. The presence of gas was not observed in the distal obstructed region, corresponding to a diagnosis of sigmoid volvulus. All three patients successfully underwent colonoscopy for volvulus reduction. Volvulus did not reoccur in any of the patients within 6 months of follow-up. It is recommended to perform abdominal X-ray imaging in patients who present with abdominal pain and distension, diarrhea, or constipation for possibly diagnosing volvulus.

Caecal Volvulus

“…As stated earlier, the role of colonoscopy is generally limited and more than 90% of patients will require surgical treatment. There have been a few reports of successful detorsion of caecal volvulus especially in children albeit with recurrence as early as 6 weeks after colonoscopy [42,43].…”

Comments on “Pediatric Sigmoid Volvulus”

“…Third, although the classical treatment way is still surgical intervention in childhood SV, in contrast to our experiments, recent reports claim endoscopic decompression by using a flexible pediatric sigmoidoscope as the first-line treatment of SV in uncomplicated cases, 1,7 as was the authors' choice.…”

“…Second, although abdominal x-ray radiography is diagnostic in 30% to 80% of patients with SV by demonstrating a dilated sigmoid colon with multiple air-fluid levels, 5,7 computed tomography is more diagnostic by showing a dilated sigmoid colon with mesenteric whirl sign, 5,6 as was demonstrated in the authors' case. In my opinion, when clinical findings and x-ray radiographies suspect an intestinal obstruction in children, if possible, computed tomography must certainly be used for an accurate diagnosis.…”

Spontaneous detorsion of sigmoid volvulus in a toddler: A timely Abdominal X-ray that clinched the diagnosis and a review of the role of radiology

“…It may resolve spontaneously but usually results in obstruction of the intestine [18]. If it resolves spontaneously without radiological investigations, it may be misdiagnosed as constipation because of the passage of stool and flatus that follows the relief of symptoms [19] or as other benign conditions with similar presentation.…”