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Volvulus-Child

Definition

A volvulus occurs when part of the large intestine is twisted on itself and the mesentery. The mesentery is a supportive tissue that anchors the intestines to the back wall of the abdomen. The twisted intestine creates a bowel obstruction that cuts off the blood supply and affects bowel function.

A volvulus requires immediate medical attention.

Causes    TOP

It is not known what causes the twisting to happen. Rarely, this may lead to bowel obstruction.

Risk Factors    TOP

Factors that increase your child’s chance of volvulus include:

  • Congenital defects including:
    • Elongated or enlarged colon
    • Congenital intestinal malrotation
    • Sigmoid colon unattached to abdominal wall
    • Narrow mesenteric connection to the colon
  • Irregular bowel habits
  • Chronic constipation
  • High fiber diet
  • Previous volvulus
  • Hirschsprung disease

Symptoms    TOP

In some cases, your child may not have symptoms. In those that have them, symptoms may include:

Diagnosis    TOP

Your child’s doctor will ask you about symptoms and medical history. A physical exam will be done. Your child’s doctor may recommend:

  • Blood tests for electrolytes
  • Hematest to check for hidden blood in the stool

Imaging tests will be needed to see your child’s internal structures. Tests include:

Treatment    TOP

The treatment goal is to unblock the obstruction and restore bowel function. Treatment may include:

Hydration

IV fluids may be given to prevent dehydration and shock. Your child may need a nasogastric tube to help prevent the build-up of gas in the stomach. A nasogastric tube is a tube inserted through the nose, down the esophagus, and into the stomach.

Medications

Your child’s doctor may recommend antibiotics if an infection is present or possible.

Surgery    TOP

Your child’s doctor will untwist the intestine and assess for any damage. In most cases, untwisting the intestine helps restore blood flow and bowel function.

If needed, the section of intestine that is damaged is removed. The two remaining healthy ends are put together with stitches or staples. This procedure may reduce the chance of another volvulus.

Prevention    TOP

There are no current guidelines to prevent volvulus.

RESOURCES:

Healthy Children—American Academy of Pediatrics
https://healthychildren.org
American Gastroenterological Association
http://www.gastro.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
https://www.cag-acg.org
Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca

References:

Antatomic problems of the lower GI tract. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract. Updated July 2013. Accessed October 2, 2017.
Intestinal malrotation and volvulus. Cincinnati Children’s Hospital website. Available at:
...(Click grey area to select URL)
Updated August 2010. Accessed October 2, 2017.
Lal SK, Morgenstern R, Vinjirayer EP, Matin A. Sigmoid volvulus an update. Gastrointest Endosc Clin N Am. 2006;16(1):175-187.
Osiro SB, Cunningham D, Shoja MM, Tubbs RS, Gielecki J, Loukas M. The twisted colon: a review of sigmoid volvulus. Am Surg. 2012;78(3):271-279.
Sigmoid volvulus. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115668/Sigmoid-volvulus. Updated September 29, 2014. Accessed October 2, 2017.
Williams H. Green for danger! Intestinal malrotation and volvulus. Arch Dis Child Educ Prac Ed. 2007;92(3):ep87-ep91.
Last reviewed September 2017 by EBSCO Medical Review Board Daus Mahnke, MD
Last Updated: 1/13/2014

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