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Hencke J, Loff S. Recurrent Sigmoid Volvulus in Children-Our Experience and Systematic Review of the Current Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1441. [PMID: 37761402 PMCID: PMC10528811 DOI: 10.3390/children10091441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Sigmoid volvulus (SV) occurs rarely in children. After encountering two cases of recurrent SV, we reviewed the literature to define the recurrence risk, identify outcome predictors and to give treatment recommendations. We found 256 cases reported in children (mean age 10.2 years, gender ratio (m:f) 2.3:1). Associations exist with Hirschsprung disease (HD) in 10%, neurodevelopmental disorders in 10.9% and chronic constipation in 10.2%. Common symptoms and clinical signs were abdominal pain (85%), distension (85%), tenderness (54%) and vomiting (59%). Signs of peritonitis were present in 14% and indicated a gangrenous sigmoid (X2 = 45.33; p < 0.001). A total of 183 had abdominal radiographs, and 65% showed a positive 'coffee-bean-sign'. Contrast enemas were positive in 90%. A total of 124 patients underwent laparotomy; in 41 cases, the sigmoid was gangrenous and associated with more complications (X2 = 15.68; p < 0.001). Non-operative treatment (NOT) like endoscopic, fluoroscopic or rectal tube decompression was performed in 135 patients and successful in 79% with a 38-57% recurrence rate. A total of 73 patients subjected to elective surgery: 50 underwent sigmoid resection; 17 had surgery for HD. Clinicians should consider SV in all children with abdominal pain, distension and vomiting. Gangrene carries a higher morbidity. After successful NOT we recommend counselling about the recurrence risk and definitive surgery should be advised. HD is frequent in newborns but sometimes found in older children.
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Affiliation(s)
- Jonathan Hencke
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, 70174 Stuttgart, Germany
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Madhavnarayan Totadri V, Vetri R, Sainath S. Pediatric Sigmoid Volvulus: A Report on Two Cases. Cureus 2022; 14:e28400. [PMID: 36168370 PMCID: PMC9506677 DOI: 10.7759/cureus.28400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/05/2022] Open
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Emeka CK. Sigmoid volvulus in a teenager. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Colonic Volvulus in Children: Surgical Management of a Challenging Condition. CHILDREN 2021; 8:children8110982. [PMID: 34828695 PMCID: PMC8625683 DOI: 10.3390/children8110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Colonic volvulus (CV) is a rare but potentially life-threatening condition with unclear etiopathogenesis. To date, less than 80 pediatric cases have been described. Hirschsprung’s disease (HD) is associated with CV in 17% of cases, representing a significant risk factor. Non-HD CV is an even more complex entity. The aim of this study is to describe a series of patients with CV to accentuate some peculiar aspects of this disease. We performed a retrospective study (period: 2012–2021) collecting information of patients with CV. Data analyzed included: demographics, medical history, presenting symptoms and radiological and surgical details. Eleven patients (12.5 ± 2.8 years; 7F/4M) had CV (eight sigmoid, two transverse colon, one total colon). Five patients had associated anomalies and three had HD. A two-step approach with volvulus endoscopic/radiological detorsion followed by intestinal resection was attempted in eight cases (one endoscopic approach failed). Three patients required surgery at admission. At follow-up, two patients developed recurrent intestinal obstruction, one of whom also had anastomotic stenosis. Colonic volvulus is a challenging condition that requires prompt patient care. A missed diagnosis could lead to severe complications. The evaluation of the patient should include a careful histological examination (searching for HD and alpha-actin deficiency), immunologic and metabolic screening, neurological tests and detection of chronic intestinal pseudo-obstruction (CIPO). Lifelong follow-up is mandatory for the early recognition and treatment of progressive diseases involving the proximal gastrointestinal tract.
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Gohsman Z, Chan A, Davis MK. Endoscopic Reduction of Sigmoid Volvulus in a 15-Year-Old Male. Glob Pediatr Health 2021; 8:2333794X211033438. [PMID: 34377744 PMCID: PMC8330459 DOI: 10.1177/2333794x211033438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Sigmoid volvulus is a well-recognized phenomenon in the elderly but rare in children. The proposed mechanism involves rotation of a redundant sigmoid loop around a narrow, elongated mesentery with subsequent vascular occlusion. The condition can be intermittent or may resolve spontaneously, complicating diagnosis. Early diagnosis is imperative to prevent ischemic complications including necrosis, perforation, and sepsis. Abdominal pain, abdominal distention, and vomiting are the most common presenting symptoms, however abdominal tenderness is uncommon. Colonic dilation is the most frequent finding on abdominal radiograph. Contrast enema reveals a "bird's beak" configuration of the twisted colon and moreover, is successful in reducing the majority of pediatric cases. If there is no evidence of bowel ischemia or perforation, endoscopic reduction has been proposed as first-line treatment for sigmoid volvulus, especially in children. We report the case of 15-year-old male in which endoscopic reduction of sigmoid volvulus was successful without complication.
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Visalli C, Trimarchi R, Spatola A, Miano SM, Salamone I. Non-invasive treatment of the sigmoid volvulus. A pediatric case report. Radiol Case Rep 2021; 16:2429-2433. [PMID: 34257774 PMCID: PMC8260760 DOI: 10.1016/j.radcr.2021.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
Sigmoid volvulus occurs when the sigmoid colic loop gets wrapped around its own mesocolon. While this condition is categorized as an extremely rare emergency in the pediatric population, diagnosis is often difficult due to the fact that its aspecific manifestations or sneaky symptoms are similar to other medical conditions. The available treatment options remain controversial up to this day, and the non-operative approach is more preferred in treating hemodynamic stable patients. This paper examines the case study of a 13-year-old girl suffering from sigmoid volvulus, who was treated with water-soluble contrast enema, in order to determine whether this method is efficient and effective in successfully treating the pathology of this condition.
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Sergi W, Serra F, Cucciarrè G, De Ruvo N, Gelmini R. Complication of Hirschsprung's disease immediately after pregnancy: A rare case report. Int J Surg Case Rep 2021; 83:105893. [PMID: 34051446 PMCID: PMC8176304 DOI: 10.1016/j.ijscr.2021.105893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
Hirschprung’s disease (HD) is a rare congenital colonic disorder. Volvulus is a rare complication of HD, described in children and adults and occasionally in infants. Diagnosis of Hirschprung’s disease was accepted. The sigmoid volvulus was HD complication appeared at the term of pregnancy. Duhamel’s procedure revealed as a safe technique to use in HD adult.
Introduction and importance Hirschprung's disease (HD) is a rare congenital colonic disorder that may develop in adult age, often determining a poor life quality with complications needing an emergency surgical setting. The disease rarely presents as an acute intestinal obstruction like SV, which represents an abdominal emergency issue. Case presentation A few days after discharge from gynecology unit because of her first childbirth, a young woman with HD developed colonic obstruction due to sigmoid volvulus, which was treated with Hartmann's procedure. Clinical discussion Some months later, the patient underwent a two-stage Duhamel's procedure to restore the digestive tract's continuity. Both hospital periods were free of critical events. Conclusion The woman regained a good quality of life: Duhamel’s procedure revealed as a safe technique to use in HD adult.
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Affiliation(s)
- William Sergi
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71, 41100, Modena, Italy.
| | - Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71, 41100, Modena, Italy.
| | - Giovanni Cucciarrè
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71, 41100, Modena, Italy.
| | - Nicola De Ruvo
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71, 41100, Modena, Italy.
| | - Roberta Gelmini
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71, 41100, Modena, Italy.
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Uylas U, Gunes O, Kayaalp C. Hirschsprung's Disease Complicated by Sigmoid Volvulus: A Systematic Review. Balkan Med J 2020; 38:1-6. [PMID: 32856883 DOI: 10.4274/balkanmedj.galenos.2020.2020.4.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Hirschsprung's disease and sigmoid volvulus can sometimes be seen in the same patient. AIMS To investigate the presence of Hirschsprung's disease in patients with sigmoid volvulus and to discuss the diagnosis and treatment methods. STUDY DESIGN Systematic review. METHODS This systematic review has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the methodological quality of systematic reviews guidelines. The PubMed and Scopus databases were scanned using the keywords "Hirschsprung* volvulus*" and "congenital aganglionic megacolon volvulus*". The reference list of the selected studies was reviewed for cross-checking. Two reviewers independently screened the available literature. Only the Hirschsprung's disease cases involving sigmoid volvulus were included, and cases of patients with volvulus in other sites was excluded. There was no restriction with respect to the publication language and type of writing. The primary outcome was morbidity and mortality. RESULTS A total of 31 cases were analyzed in 22 articles; 97% of the patients were under the age of 40, 90% were male. There was a statistically significant difference in the necessity for relaparotomy between patients who were scheduled for sigmoid volvulus therapy with the suspicion of Hirschsprung's disease and patients who were treated without suspicion of Hirschsprung's disease (0% vs 37.5%, p=0.02). While there was no postoperative death in cases with suspected Hirschsprung disease, this mortality rate was 25% in cases without suspicion (p = 0.08). CONCLUSION Hirschsprung's disease should be excluded with rectal biopsy if a patient with sigmoid volvulus is under 40 years of age and has complaints of constipation from childhood.
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Affiliation(s)
- Ufuk Uylas
- Department of Gastroenterology Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Orgun Gunes
- Department of Gastroenterology Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastroenterology Surgery, İnönü University School of Medicine, Malatya, Turkey
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Shahramian I, Bazil A, Ebadati D, Rostami K, Delaramnasab M. Colonoscopic decompression of childhood sigmoid and cecal volvulus. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:221-225. [PMID: 29749331 DOI: 10.5152/tjg.2018.17507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cases of colonic volvulus in children are infrequently described in the literature. Here we describe the case of three patients with colonic volvulus. The first patient was a 10-year-old girl with abdominal dilation and pain and no bowel movement for 48 h. Her abdominal X-ray showed the coffee bean sign adjacent to the diaphragm, which was compatible with a diagnosis of cecal volvulus. The second patient was a 4-year-old boy with a history of chronic constipation during the past year and with no bowel movement for 24 h. Clinical manifestations included severe nausea, vomiting, and abdominal distension. His abdominal X-ray demonstrated the coffee bean sign in the right upper quadrant with upward convexity corresponding to a diagnosis of sigmoid volvulus. The third patient was a 10-month-old male who presented with excessive crying, malnutrition, and no bowel movement for 36 h. His abdominal X-ray demonstrated the coffee bean sign in the left upper quadrant with upward convexity. The presence of gas was not observed in the distal obstructed region, corresponding to a diagnosis of sigmoid volvulus. All three patients successfully underwent colonoscopy for volvulus reduction. Volvulus did not reoccur in any of the patients within 6 months of follow-up. It is recommended to perform abdominal X-ray imaging in patients who present with abdominal pain and distension, diarrhea, or constipation for possibly diagnosing volvulus.
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Affiliation(s)
- Iraj Shahramian
- Pediatric Digestive and Hepatic Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Ali Bazil
- Pediatric Digestive and Hepatic Research Center, Zabol University of Medical Sciences, Zabol, Iran; Clinical Research Development Unit, Zabol University of Medical Sciences, Amir-Al-Momenin Hospital, Zabol, Iran
| | - Danial Ebadati
- Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran
| | - Karim Rostami
- Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran
| | - Mojtaba Delaramnasab
- Pediatric Digestive and Hepatic Research Center, Zabol University of Medical Sciences, Zabol, Iran; Clinical Research Development Unit, Zabol University of Medical Sciences, Amir-Al-Momenin Hospital, Zabol, Iran
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Atamanalp SS. Reply to 'Comments on a new classification, treatment algorithm and prognosis-estimating system for sigmoid volvulus: factors affecting recurrence'. Colorectal Dis 2018; 20:821-822. [PMID: 29992741 DOI: 10.1111/codi.14338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 02/08/2023]
Affiliation(s)
- S S Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Carmo L, Amaral M, Trindade E, Henriques-Coelho T, Pinho-Sousa J. Sigmoid Volvulus in Children: Diagnosis and Therapeutic Challenge. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:264-267. [PMID: 30320166 DOI: 10.1159/000486242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/11/2017] [Indexed: 11/19/2022]
Abstract
Background Sigmoid volvulus is a rare condition in children. Early diagnosis increases the success of nonsurgical treatment in the emergency department, but posterior elective surgery is important due to the risk of recurrence. Methods/Conclusions We present the case of a healthy 16-year-old girl with recurrent volvulus and successful endoscopic treatment followed by elective surgery.
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Affiliation(s)
- Leonor Carmo
- Department of Pediatric Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Marina Amaral
- Department of Pediatric Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Eunice Trindade
- Department of Pediatric Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | | | - José Pinho-Sousa
- Department of Pediatric Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
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