Sigmoidal volvulus in childhood: report of two cases

Sigmoid volvulus in a young patient

The case of an 18-year-old man with sigmoid volvulus and recurrent abdominal pain is presented. He was seen in the emergency department three times in a 4-month period, each time complaining of cramping left lower quadrant pain of one to two hours duration without vomiting or diarrhea. Physical examination on each occasion revealed left lower quadrant tenderness without mass, guarding, or rebound. Radiologic evaluation on the first visit revealed sigmoid volvulus, which was reduced by barium enema. Despite identical clinical presentation on two subsequent occasions, radiologic studies showed no evidence of recurrent volvulus. During the ensuing two years, the patient has had no further symptoms.

Childhood sigmoid volvulus

A 14-year-old boy presented to the emergency department with abdominal pain. Flat and upright abdominal films and a barium enema revealed the classic findings of sigmoid volvulus. Sigmoidoscopy allowed a soft rubber tube to be passed beyond the obstruction with immediate relief of pain. The patient subsequently underwent a descending sigmoid colectomy. Sigmoid volvulus is a rare entity in childhood. Case discussion and review of the literature is presented.

Large bowel volvulus in children. Review of a case material and the literature

Four pediatric patients with volvulus of the right colon, and three others with twisting of the sigmoid colon are reported. The clinical manifestations, mainly pain, were vague. Radiological plain film findings were occasionally characteristic, but were in the majority of cases equivocal. An active radiological approach including a supplementary barium enema in any patient with inconclusive plain abdominal roentgenograms will, in addition to other unexpected diagnoses, reveal rare cases of large bowel volvulus. Elective surgical procedures, carried out on viable bowel do not necessarily provide advantages over a non-operative approach. In addition spontaneous reduction of the volvulus may result in permanent cure.