Sami Tannouri1, Aditi Hendi2, Elizabeth Gilje3, Leslie Grissom4, Douglas Katz5. 1. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Sami.Tannouri@Jefferson.edu. 2. Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. 3. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. 4. Department of Radiology, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA. 5. Department of Pediatric Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA.
Abstract
BACKGROUND/ PURPOSE: Pediatric colonic volvulus is both rare and underreported. Existing literature consists only of case reports and small series. We present an analysis of cases (n=11) over 15 years at a single institution, focusing on workup and diagnosis. METHODS: This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring over 15 years (2000-2015). RESULTS: In our series, the most common presenting symptoms were abdominal pain and distention. Afflicted patients often had prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Of the imaging modalities utilized in the 11 patients studied, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, CT in 55.6% of cases and by plain radiography of the abdomen in only 22.2%of cases. Colonic volvulus was confirmed by laparotomy in all cases. The cecum (n=5) was the most often affected colonic segment, followed by the sigmoid (n=3). Operative treatment mainly consisted of resection (63.6%) and ostomy creation (36.4%). Colopexy was performed in 18.2% of cases. CONCLUSIONS: Plain abdominal radiography may be performed as an initial diagnostic study, however, it should be followed CT or air or contrast enema in children where there is high clinical suspicion and who do not have indications for immediate laparotomy. CT may be the most specific and useful test in diagnosis of colonic volvulus and has the added advantage of detection of complications including bowel ischemia. We demonstrate a range of diagnostic and therapeutic modalities for pediatric colonic volvulus. This underscores the need for further study to draft standard best practices for this life-threatening condition. LEVEL OF EVIDENCE: Prognosis Study: Level IV. Study of a Diagnostic Test: Level III.
BACKGROUND/ PURPOSE:Pediatric colonic volvulus is both rare and underreported. Existing literature consists only of case reports and small series. We present an analysis of cases (n=11) over 15 years at a single institution, focusing on workup and diagnosis. METHODS: This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring over 15 years (2000-2015). RESULTS: In our series, the most common presenting symptoms were abdominal pain and distention. Afflicted patients often had prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Of the imaging modalities utilized in the 11 patients studied, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, CT in 55.6% of cases and by plain radiography of the abdomen in only 22.2%of cases. Colonic volvulus was confirmed by laparotomy in all cases. The cecum (n=5) was the most often affected colonic segment, followed by the sigmoid (n=3). Operative treatment mainly consisted of resection (63.6%) and ostomy creation (36.4%). Colopexy was performed in 18.2% of cases. CONCLUSIONS: Plain abdominal radiography may be performed as an initial diagnostic study, however, it should be followed CT or air or contrast enema in children where there is high clinical suspicion and who do not have indications for immediate laparotomy. CT may be the most specific and useful test in diagnosis of colonic volvulus and has the added advantage of detection of complications including bowel ischemia. We demonstrate a range of diagnostic and therapeutic modalities for pediatric colonic volvulus. This underscores the need for further study to draft standard best practices for this life-threatening condition. LEVEL OF EVIDENCE: Prognosis Study: Level IV. Study of a Diagnostic Test: Level III.
Authors: Mauricio Gonzalez-Urquijo; Christian Ovalle-Chao; Eduardo Flores-Villalba; Ulises de Jesus Garza-Luna; Jose Humberto Velazco-De La Garza; Ulises Garza-Serna Journal: European J Pediatr Surg Rep Date: 2018-01-08