Childhood Volvulus

Childhood Volvulus

Article
Digestive Health
Kids' Zone
+2
Contributed byMaulik P. Purohit MD MPHNov 08, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Gastric Volvulus in Infants and Children
  • Infant Volvulus
  • Intestinal Volvulus 

What is Childhood Volvulus? (Definition/Background Information)

  • Childhood Volvulus is defined as the abnormal twisting of a loop of the bowel, leading to obstruction in the intestine and decreased blood supply. This may cause the death of the tissue (bowel and fat surrounding the bowel)
  • This disorder affects very young infants. It is frequently caused by intestinal malrotation, a condition that occurs due to the abnormal development of the intestines
  • Abdominal pain, swelling, green vomit, dark or blood stools, are some of the indications of Childhood Volvulus, which is an emergency pediatric situation
  • An early diagnosis of this abnormality with surgical management is necessary to prevent life-threatening consequences
  • The prognosis of Childhood Volvulus is good with prompt treatment

Who gets Childhood Volvulus? (Age and Sex Distribution)

  • Childhood Volvulus most commonly occurs in children younger than 12 months old; it is most common in neonates below a month old (about 60% of the cases)
  • Both girl babies and boy babies may be affected
  • No racial or ethnic predilection is seen

What are the Risk Factors for Childhood Volvulus? (Predisposing Factors)

  • The most important risk factor for Childhood Volvulus is malrotation, which means the normal intestinal rotation is incomplete and the bowel is not fixed. Malrotation is a congenital condition
  • However, any abdominal wall defects and digestive system defects, present at birth are risk factors for the disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Childhood Volvulus? (Etiology)

  • In children with malrotation, the blood supply to the bowel is through a very narrow structure, called mesentery. Since, the intestine is not properly fixed, the bowel may twist on its own blood supply
  • This causes an obstruction and the blood supply to the twisted part of the bowel is lost, which can lead to the death of that segment of the bowel. This is the cause of Infant or Childhood Volvulus

What are the Signs and Symptoms of Childhood Volvulus?

The signs and symptoms of Childhood Volvulus include:

  • Nausea
  • Vomiting green material
  • Abdominal pain, swollen abdomen
  • Stools with blood or dark red stools
  • Constipation
  • Child irritability
  • Pulling up the legs while crying 

How is Childhood Volvulus Diagnosed?

Childhood Volvulus may be diagnosed as follows:

  • Physical examination with assessment of the child’s signs and symptoms
  • Stool guaiac test: To check for the presence of blood in stool
  • Blood electrolyte levels; since, vomiting can lead to decreased sodium and potassium levels in the body
  • X-ray of abdomen: This tool can show, if there is any obstruction in the bowel
  • Barium enema: A procedure in which a contrast material is introduced through the rectum, to detect any bowel abnormalities
  • Ultrasound, CT scan of abdomen: This helps confirm malrotation by locating the position of the blood vessels (mesentery) to the bowel

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Childhood Volvulus?

Childhood Volvulus may cause the following complications:

  • Death of the bowel can lead to superimposed infection inside the abdomen (peritonitis)
  • Removal of large portion of the bowel during surgery (performed for rectification of defect) can lead to malnutrition 

How is Childhood Volvulus Treated?

Childhood Volvulus is a life-threatening condition that necessitates immediate management of the intestinal abnormality. A treatment of the condition may be undertaken as follows:

  • The following supportive measures are performed before surgery:
    • Insertion of a tube through mouth (orogastric tube) to decompress the stomach
    • Aggressive fluid management by administering intravenous fluids, to prevent dehydration due to vomiting
    • Correction of electrolyte imbalances
  • Emergent surgery: Using Ladd’s procedure, the bowels are untwisted, resulting in the restoration of blood supply. Also, the part of the bowel that is devoid of blood supply is removed, to prevent any infection 

How can Childhood Volvulus be Prevented?

Currently, there are no known methods to prevent the occurrence of Infant Volvulus (or Childhood Volvulus). 

What is the Prognosis of Childhood Volvulus? (Outcomes/Resolutions)

  • The outcome of Childhood Volvulus is usually good, when the condition is diagnosed early and emergent surgery performed
  • However, removal of large amounts of bowel tissue can lead to deprivation of nutrients in children, since most of the nutrients are absorbed through the intestinal walls 

Additional and Relevant Useful Information for Childhood Volvulus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/digestive-center/

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Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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