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Updated: Feb 13 2018

Volvulus

3.8

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(5)

Images
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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