Updated: 2/13/2018

Volvulus

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https://upload.medbullets.com/topic/106023/images/sigmoid_volvulus.jpg
Snapshot
  • A 2-day-old neonate presents with bilious vomiting and irritability. On physical examination, she has abdominal distention and high-pitched bowel sounds. Barium enema radiograph reveals a dilated sigmoid colon with a column of barium resembling a "coffee bean".
Introduction
  • Malrotation of gut from errors during development increases risk of volvulus
  • Volvulus (typically, midgut) 
    • abnormal rotation of bowel
    • strangulation of SMA
    • compromised blood flow to bowel
  • Epidemiology
    • most common in newborns
    • males > females
  • Associated conditions
    • situs inversus
    • cardiovascular defects
    • heterotaxy
    • gastroschisis/omphalocele
Presentation
  • Symptoms
    • neonates
      • bilious vomiting within first week of life
      • colicky pain
    • older patients
      • bilious or nonbilious vomiting
      • crampy abdominal pain
      • change in bowel pattern
      • nausea
  • Physical exam
    • abdominal distention
    • abdominal tenderness
Evaluation
  • abdominal radiography
    • may have air fluid levels
  • upper GI imaging with barium enema
    • “bird beak” appearance at site of rotation
    • failure of duodenum to cross midline = malrotation
Differential Diagnosis
  • Intussusception
  • Intestinal atresia 
  • Gastroenteritis
  • Appendicitis
  • Meckel diverticulum
Treatment
  • Malrotation without volvulus
    • elective Ladd procedure
  • Malrotation with volvulus (symptomatic or acute abdomen)
    • emergent endoscopic decompression
    • surgical decompression
Prognosis, Prevention, and Complications
  • Prognosis
    • good with treatment
  • Complications
    • bowel necrosis
    • perforation
    • sepsis

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