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Volvulus - childhood

Childhood volvulus; Abdominal pain - volvulus

A volvulus is a twisting of the intestine that can occur in childhood. It causes a blockage that may cut off blood flow. Part of the intestine may be damaged as a result.

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Causes

A birth defect called intestinal malrotation can make an infant more likely to develop a volvulus. However, a volvulus can occur without this condition present.

Volvulus due to malrotation occurs most often in the first year of life.

Symptoms

Common symptoms of volvulus are:

• Bloody or dark red stools
• Constipation or difficulty releasing stools
• Distended abdomen
• Pain or tenderness in the abdomen
• Nausea or vomiting
• Shock
• Vomiting green material

Symptoms are very often severe and require emergency care. Early treatment can be critical for survival.

Exams and Tests

Your health care provider may order the following tests to diagnose the condition:

• Barium enema
• Blood tests to check electrolytes
• CT scan
• Stool guaiac (shows blood in the stool)
• Upper GI series

Treatment

In some cases, colonoscopy can be used to correct the problem. This involves use of a flexible tube with a light on the end that is passed into the colon (large bowel) through the rectum.

Emergency surgery is often needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply is restored.

If a small segment of bowel is dead from a lack of blood flow (necrotic), it is removed. The ends of the bowel are then sewn together. Or, they are used to form a connection of the intestines to the outside of the body (colostomy or ileostomy). Bowel contents can be removed through this opening.

Outlook (Prognosis)

Most of the time, prompt diagnosis and treatment of volvulus leads to a good outcome.

If the bowel is dead, the outlook is poor. The situation may be fatal, depending on how much of the bowel is dead.

Possible Complications

Possible complications of volvulus are:

• Secondary peritonitis
• Short bowel syndrome (after removal of a large part of the small bowel)

When to Contact a Medical Professional

This is an emergency condition. The symptoms of childhood volvulus develop quickly and the child will become very ill. Get medical attention right away if this happens.

Related Information

Fetal development
Intestinal obstruction and Ileus
Abdominal pain
Shock
Peritonitis - secondary
Short bowel syndrome

References

Maqbool A, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 332.

Mokha J. Vomiting and nausea. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 8.

Srinath A, Rudolph JA. Nutrition and gastroenterology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 11.

Thomas N, Wu AW. Large intestine. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 81.

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Review Date: 7/30/2022  

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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