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==Background==
==Background==
*2 types: Sigmoid and cecal volvulus
*Surgical emergency
*Can occur at any time
**1st week of life: 33%
**1st month of life: 50%
**1st year of life: 85%
==Clinical Features==
*Classic Triad: [[Special:MyLanguage/Abdominal pain (peds)|abdominal pain]], increased abdominal distention, [[Special:MyLanguage/Constipation (peds)|constipation]]
*Alternative Presentation: bilious [[Special:MyLanguage/Nausea and vomiting (peds)|vomiting]], abdominal distension, tenderness, and a palpable mass
**Vomiting seen in 50% of cases
*[[Special:MyLanguage/Pediatric shock|Shock]] and [[Special:MyLanguage/peritonitis|peritonitis]] if perforated
==Differential Diagnosis==
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{{Pediatric abdominal pain DDX}}
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{{Constipation DDX}}
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==Evaluation==




* can occur any time but 75% of cases in 1st month of life, d/t Ladd's bands lead to rotation.
===Imaging===


==Diagnosis==
*Should not delay surgical consult
*[[Special:MyLanguage/KUB|Abdominal XR]]
**Sigmoid volvulus
***Classically see "coffee bean sign" - large, distended colon with gas that seems to be bent over itself, making coffee bean shape
***Can also perform contrast enema, look for "bird beak" sign
***Frimann Dahl's sign
***Absent rectal gas
**Cecal volvulus
***May see findings similar to small bowel obstruction
****Air-fluid level, paucity of gas
***Distended loop of colon with haustral markings
**Malrotation with midgut volvulus
***Upper GI with contrast
****Obstructed duodenum with corkscrew appearance
****Misplaced duodenum as demonstrated by NG tube
****May see double-bubble sign due to obstruction
***US may show SMA compromise
*CT Abd/pelvis
**Highly sensitive and specific for volvulus
**Usually not necessary in cecal volvulus
**May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign"




* S/S: sudden onset vomiting, abd pain & feeding intol in an otherwise healthy infant, bilious vomiting in 77-100% of cases. Volume depletion, grunting resps, jaundice (33%), shock, diffuse abd tenderness, bloody stools (late).* In '93 Torres etal found 22 pts undergoing surgery for malrotation 50% had nl abd exams and 32% had distension but no tenderness.
==Management==


* AXR* dilated stomach & duodenum w/o distal gas
*Emergent surgical consult
* can have nl xr.
*Place [[Special:MyLanguage/NG tube|NG tube]]
* upper GI series shows narrowing at site of obstruction with corckscrewing around the SMA
*[[Special:MyLanguage/Fluid resuscitation|Fluid resuscitation]]
* Clockwise whirlpool sign using color doppler flow has a sensitivity 92%,spec 100%,PPV 100%
*[[Special:MyLanguage/Antibiotics|Antibiotics]] if gangrenous bowel is suspected (triple coverage with ampicillin, gentamicin, metronidazole)
*Sigmoid volvulus may be managed non-operatively by endoscopic detorsion
**Successful in 50-90% of cases
**Contraindicated if perforation or gangrenous bowel suspected
*All cases of cecal volvulus should be managed operatively




==DDx==
==Disposition==


*Admit


* duodenal webs, duodenal stenosis, duodenal or ileal atresia, ileus (but bilious vomiting in a young infant IS THIS DZ UNTIL proven otherwise)


==Treatment==
==See Also==


*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]]
*[[Special:MyLanguage/Volvulus (Adults)|Volvulus (Adults)]]


* supportive care w/ aggressive fluids, NGT, ABX (amp, gent, clinda)
* Stable pt can have UGI series to confirm Dx
* shock pt needs surgery asap "time is bowel" (6 hr before bowel is dead)


==References==


<references/>


[[Category:Peds]]
[[Category:Pediatrics]]
[[Category:GI]]
[[Category:Surgery]]
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Revisión actual - 17:15 17 ene 2026


This page is for pediatric patients. For adult patients, see: volvulus


Background

  • 2 types: Sigmoid and cecal volvulus
  • Surgical emergency
  • Can occur at any time
    • 1st week of life: 33%
    • 1st month of life: 50%
    • 1st year of life: 85%


Clinical Features


Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence

Constipation


Evaluation

Imaging

  • Should not delay surgical consult
  • Abdominal XR
    • Sigmoid volvulus
      • Classically see "coffee bean sign" - large, distended colon with gas that seems to be bent over itself, making coffee bean shape
      • Can also perform contrast enema, look for "bird beak" sign
      • Frimann Dahl's sign
      • Absent rectal gas
    • Cecal volvulus
      • May see findings similar to small bowel obstruction
        • Air-fluid level, paucity of gas
      • Distended loop of colon with haustral markings
    • Malrotation with midgut volvulus
      • Upper GI with contrast
        • Obstructed duodenum with corkscrew appearance
        • Misplaced duodenum as demonstrated by NG tube
        • May see double-bubble sign due to obstruction
      • US may show SMA compromise
  • CT Abd/pelvis
    • Highly sensitive and specific for volvulus
    • Usually not necessary in cecal volvulus
    • May be helpful in diagnosis of sigmoid volvulus, look for "whirl sign"


Management

  • Emergent surgical consult
  • Place NG tube
  • Fluid resuscitation
  • Antibiotics if gangrenous bowel is suspected (triple coverage with ampicillin, gentamicin, metronidazole)
  • Sigmoid volvulus may be managed non-operatively by endoscopic detorsion
    • Successful in 50-90% of cases
    • Contraindicated if perforation or gangrenous bowel suspected
  • All cases of cecal volvulus should be managed operatively


Disposition

  • Admit


See Also


References

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