Sigmoid volvulus as a rare cause of intestinal obstruction in the pediatric population: case series and literature review

Abstract

Introduction: Sigmoid volvulus is an uncommon cause of intestinal obstruction in the pediatric population. This pathology is associated with intestinal malrotation and sometimes with the presence of internal hernias. The clinical presentation includes pain, abdominal distension, and emesis; however, sometimes patients report nonspecific chronic symptoms. Among the diagnostic tools commonly used in children are radiography and abdominal tomography. There are multiple treatment strategies ranging from endoscopic to surgical procedures including resection with stoma creation. Timely diagnosis is crucial given the increased morbidity and mortality resulting from intestinal ischemia and perforation. Methods: A review of the medical records of the patients with a diagnosis of sigmoid volvulus treated by pediatric surgeons of the institution and led to devolvulation and subsequent sigmoidectomy presented below was carried out. Likewise, a literature search was carried out in electronic databases, using two equations using terms selected from ‘Medical Subject Heading’ (MeSH) and ‘Descriptors in Health Sciences’ (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool for the construction of the manuscript. Results: Upon continuation, the experience of six patients between the ages of 5 and 17 with a diagnosis of sigmoid volvulus between the years 2021 and 2023 is presented. These patients were taken to initial decompression by different approaches and in a second surgical stage to sigmoidectomy, most of them with anastomosis. All patients had an adequate postoperative evolution without complications. Conclusion: Sigmoid volvulus is a rare condition in pediatrics with a variable and sometimes nonspecific clinical presentation; however, given the increased morbidity and mortality resulting from a delay in diagnosis, it is important to consider the clinical, paraclinical, and radiological findings that allow early identification as a cause of intestinal obstruction.