Korean J Pediatr Gastroenterol Nutr.  2010 Sep;13(2):199-203. 10.5223/kjpgn.2010.13.2.199.

A Case of Sigmoid Volvulus in a Child

• Lee DH
• We JH
• Park HS
• Kim HY
• Park JH

• KMID: 1459436
• DOI: http://doi.org/10.5223/kjpgn.2010.13.2.199

Abstract

Sigmoid volvulus may cause acute or subacute colonic obstruction. Excessive length of the sigmoid colon may be a contributing factor. Typically, the patient develops bilious vomiting and marked gaseous abdominal distension. We report a case of sigmoid volvulus in a 9-year-old boy who presented with recurrent, sudden onset abdominal pain, abdominal distension, and vomiting for 1 year, which was diagnosed by simple abdominal X-ray, barium enema, computed tomography, and colonoscopic examination. Colonoscopic reduction failed and a sigmoid colectomy with primary repair was performed. The intra-operative findings showed that the sigmoid colon was noted to be dilated, and redundant with a lax mesentery. Two clear areas of compression (proximal and distal) were present. After sigmoidectomy, the symptoms resolved. After 5 years of follow-up, he had no new symptoms.

Keyword

Sigmoid volvulus; Child

MeSH Terms

Abdominal Pain
Barium
Child
Colectomy
Colon
Colon, Sigmoid
Enema
Follow-Up Studies
Humans
Intestinal Volvulus
Mesentery
Vomiting
Barium

Figure

• 

  Fig. 1 Simple abdominal radiograph reveals markedly dilated loops of the colon without rectal gas.

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  Fig. 2 Barium study shows progressive tapered rectosigmoid tract (arrow) and dilated proximal sigmoid loop.

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  Fig. 3 Abdominal computed tomography shows the 'whirl sign' (arrow) caused by torsion of the sigmoid mesentery.

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  Fig. 4 Colonoscopy shows abnormal mucosal fold (A), luminal tapering from the rectosigmoid junction and counterclock-wise colon (B).

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  Fig. 5 Photography shows markedly dilated and long sigmoid and abnormal mesocolon.

Reference

1. Bruusgaard C. Volvulus of the sigmoid colon and its treatment. Surgery. 1947. 22:466–478.

2. Smith SD, Golladay ES, Wagner C, Seibert JJ. Sigmoid volvulus in childhood. South Med J. 1990. 83:778–781.

3. Arnold GJ, Nance FC. Volvulus of the colon. Ann Surg. 1973. 177:527–537.

4. Theuer C, Cheadle WG. Volvulus of the colon. Am Surg. 1991. 57:145–150.

5. Morrissey TB, Deitch EA. Recurrence of the sigmoid volvulus after surgical intervention. Am Surg. 1994. 60:329–331.

6. Werkin MG, Aufses AH Jr. Management of volvulus of the colon. Dis Colon Rectum. 1978. 21:40–45.

7. Lee HK, Choi SJN. Chronic constipation led to sigmoid volvulus in a child. J Korean Surg Soc. 2009. 77:441–444.

8. Cook ES, Allison EJ Jr. Sigmoid volvulus in a young patient. Ann Emerg Med. 1984. 13:963–966.

9. Ismail A. Recurrent colonic volvulus in children. J Pediatr Surg. 1997. 32:1739–1742.

10. Puneet , Khanna R, Gangopadhyay AN, Shahoo SP, Khanna AK. Sigmoid volvulus in childhood: report of six cases. Pediatr Surg Int. 2000. 16:132–133.

11. Carter R, Hinshaw DB. Acute sigmoid volvulus in children. Am J Dis Child. 1961. 101:631–634.

12. Salas S, Angel CA, Salas N, Murillo C, Swischuk L. Sigmoid volvulus in children and adolescents. J Am Coll Surg. 2000. 190:717–723.

13. Kim JH, Kim JY, Kwon KA, Chung MG, Yeon JE, Park JJ, et al. Clinical analysis of sigmoid volvulus. Intest Res. 2005. 3:117–120.

14. Gibney EJ. Volvulus of the sigmoid colon. Surg Gynecol Obstet. 1991. 173:243–255.

15. Renzulli P, Maurer CA, Netzer P, Büchler MW. Preoperative colonoscopic derotation is beneficial in acute colonic volvulus. Dig Surg. 2002. 19:223–229.

16. Brothers TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg. 1987. 206:1–4.