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Sigmoid Colon Volvulus in Early Infancy: Do Not Miss It!

Armon, Yaron MD*; Koplewitz, Benjamin Z MD; Elazary, Ram MD; Arbell, Dan MD*

Journal of Pediatric Gastroenterology and Nutrition: December 2010 - Volume 51 - Issue 6 - p 689
doi: 10.1097/MPG.0b013e3181f41859
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*Department of Pediatric Surgery, Israel

Department of Medical Imaging, Israel

Deparment of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Address correspondence and reprint requests to Dr Yaron Armon, Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, PO Box 12000, IL-91120 Jerusalem, Israel (e-mail: ayaron@hadassah.org.il).

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 7-week-old previously healthy boy presented at our emergency department with apathy and abdominal distention. Plain abdominal films showed dilated bowel loops suggestive of distal obstruction (Fig. 1A). Sonography showed a moderate amount of free fluid and ruled out intussusception. Repeat films were suspicious for a closed loop obstruction (Fig. 1B). Operative treatment was chosen because diagnosis was not clear. Surgery revealed sigmoid volvulus due to a narrow mesentery neck. The bowel was viable, and detorsion was performed. Recovery was uneventful, and postoperative rectal biopsy was normal.

FIGURE 1

FIGURE 1

Volvulus of the sigmoid colon is a rare cause of bowel obstruction occurring mostly in the adult population. It is exceedingly rare in infancy (1). Presenting symptoms are abdominal distention, obstipation, and vomiting. Delay in intervention—radiological, endoluminal, or surgical (2)—may lead to bowel infarction with high mortality (22%–50% in infants) (3). A high level of suspicion will lead to timely intervention and is the only way to salvage the bowel. Treatment may consist of detorsion alone or with sigmoidopexy, avoiding the need for resection or colostomy. The recurrence rate in this population is low (3) and sigmoidoscopy could suffice. Further investigations aimed toward anorectal anomalies or Hirschsprung disease should be carried out after convalescence (4).

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REFERENCES

1. Ballantyne GH, Brandner MD, Beart RW, et al. Volvulus of the colon incidence and mortality. Ann Surg 1985; 202:83–2.
2. Salas S, Angel CA, Salas N, et al. Sigmoid volvulus in children and adolescents. J Am Coll Surg 2000;190:717–23.
3. Atamanalp SS, Yildirgan MI, Basoglu M, et al. Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004;20:492–95.
4. Teich S, Schisgall RM, Anderson KD. Ischemic enterocolitis as a complication of Hirschsprung's disease. J Pediatr Surg 1986;21:143–45.
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