Sigmoid volvulus in children: a case report

Abstract

BackgroundSigmoid volvulus is frequently reported in the “volvulus belt” (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause of large bowel obstruction in North America.It is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to diagnose sigmoid volvulus in children.Case presentationWe present a 13-year-old Arabian girl who came with features suggestive of intestinal obstruction. Plain abdominal film revealed classic omega (coffee bean) sign of sigmoid volvulus. The volvulus was successfully decompressed by means of a rectal tube in our emergency department. The next day during the same admission the volvulus recurred and was successfully decompressed by endoscopy. She was discharged home on her parents’ request; she presented again 1 month later. This time the volvulus could not be decompressed non-operatively, so she underwent sigmoidectomy with primary anastomosis. Postoperatively she developed paralytic ileus that resolved after 10 days. Following that she did well and was discharged home. She is still free of symptoms 1 year after the resection.ConclusionsSigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group as a cause of intestinal obstruction. Pediatric surgeons should maintain a high index of suspicion, in order not to miss this important diagnosis, as any delay in instituting treatment has a devastating effect on morbidity as well as mortality. Early diagnosis and prompt treatment confer an excellent prognosis.

Pediatric sigmoid volvulus of an extremely long sigmoid colon with hypoganglionosis: a case report

“…1 If a non-operative approach is unsuccessful at reducing the volvulus or the patient develops signs of perforation/peritonitis, then immediate surgery is warranted. 2 We decided to operate because of the greatly dilated colon and fear of perforation in our case. According to Salas et al., 14 sigmoidectomy with either primary anastomosis or colostomy is the definitive treatment for SV.…”

“…However, a characteristic geographical distribution of SV is absent in the pediatric population, and thus the cause of SV is unclear. 1,2 The exact incidence of SV in children is still unknown. There have only been a few case reports and a relatively small case series on SV, with only 93 cases of SV reported worldwide by 2007, 1,3 and only a few more reported by 2020.…”

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.…”

“…Abdominal pain, distention, and constipation are the classical triad of symptoms in acute sigmoid volvulus. Additional complaints include vomiting, nausea, diarrhea, anorexia, rectal bleeding, and hematemesis [ 10 , 13 ]. Our patient had an acute presentation with the classic triad of abdominal pain, distention, and absolute constipation.…”

“…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%. Nevertheless, emergency surgery is required for patients in whom peritonitis, bowel gangrene, or perforation is present or in those for whom non-operative treatment is unsuccessful [ 3 , 5 , 10 ]. After successful endoscopic reduction of the colon, the recurrence of SV was achieved in up two-thirds of the cases.…”