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Risk Factors for Intestinal Gangrene in Children With Small-bowel Volvulus

Lin, Yu-Pi*; Lee, Jung*; Chao, Hsun-Chin*; Kong, Man-Shan*; Lai, Ming-Wei*; Chen, Chien-Chang*; Chen, Shih-Yen*; Luo, Chih-Cheng

Journal of Pediatric Gastroenterology and Nutrition: October 2011 - Volume 53 - Issue 4 - p 417–422
doi: 10.1097/MPG.0b013e3182201a7c
Original Articles: Gastroenterology

Objectives: Pediatric small-bowel volvulus (SBV) is a surgical emergency, and early diagnosis is difficult. We analyzed the clinical manifestations, imaging findings, and laboratory parameters in children with SBV and attempted to determine the risk factors for bowel gangrene.

Patients and Methods: Forty-nine children (35 boys and 14 girls) with SBV who were admitted to the hospital for a period of 13 years were enrolled. Clinical and laboratory parameters and evaluation measures included fever, abdominal pain, vomiting, bloody stool, peritoneal signs, severe dehydration, disease duration, white blood cell counts, sugar, C-reactive protein (CRP), sodium, potassium, metabolic acidosis, blood urea nitrogen, and creatinine. These parameters were statistically compared between patients with and without bowel gangrene.

Results: Thirty-six patients (73.5%) were 5 years old or younger, and nearly half were younger than 1 year old. Abdominal pain and vomiting were 2 major symptoms. Malrotation was the most common cause of SBV. In univariate analysis, nonbilious vomiting, peritoneal signs, severe dehydration, leukocytosis (WBC count >18,000 cells/mm3), elevated CRP (>50 mg/dL), and hyponatremia (<130 mmol/L) were significantly associated with bowel gangrene (P < 0.05). In multivariate analysis, nonbilious vomiting, leukocytosis, and elevated CRP were significantly (P < 0.05) associated with bowel gangrene. The resection rate for bowel gangrene was 44.9%, and no mortality was found. Seven (14.3%) patients had postoperative complications, including short-bowel syndrome (n = 2), adhesion ileus (n = 3), and intraabdominal abscess (n = 3). Seven experienced failure to thrive in later follow-up.

Conclusions: Specific clinical manifestations and laboratory parameters are helpful in the identification of bowel gangrene in children with SBV.

*Department of Pediatric Gastroenterology

Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Address correspondence and reprint requests to Hsun-Chin Chao, MD, Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, 5 Fu-Hsing St, Kuei-Shan, 33305, Taoyuan, Taiwan (e-mail:

Received 12 December, 2010

Accepted 17 April, 2011

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN