Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(2) > 1043472

Korean J Pediatr Gastroenterol Nutr. 2010 Sep;13(2):199-203. Korean.
Published online September 30, 2010.  https://doi.org/10.5223/kjpgn.2010.13.2.199
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
A Case of Sigmoid Volvulus in a Child
Dong Han Lee, B.A., Ju Hee We, M.D.,* Hyun Seok Park, M.D.,* Hae Young Kim, M.D., and Jae Hong Park, M.D.*
Postgraduate School of Medicine, Pusan National University, Busan, Korea.
*Department of Pediatrics, Pusan National University, Busan, Korea.
Department of Surgery, Pusan National University, Busan, Korea.

Corresponding author (Email: jhongpark@pusan.ac.kr )
Received August 08, 2010; Revised August 12, 2010; Accepted September 06, 2010.

Abstract

Sigmoid volvulus may cause acute or subacute colonic obstruction. Excessive length of the sigmoid colon may be a contributing factor. Typically, the patient develops bilious vomiting and marked gaseous abdominal distension. We report a case of sigmoid volvulus in a 9-year-old boy who presented with recurrent, sudden onset abdominal pain, abdominal distension, and vomiting for 1 year, which was diagnosed by simple abdominal X-ray, barium enema, computed tomography, and colonoscopic examination. Colonoscopic reduction failed and a sigmoid colectomy with primary repair was performed. The intra-operative findings showed that the sigmoid colon was noted to be dilated, and redundant with a lax mesentery. Two clear areas of compression (proximal and distal) were present. After sigmoidectomy, the symptoms resolved. After 5 years of follow-up, he had no new symptoms.

Keywords: Sigmoid volvulus; Child

Figures


Fig. 1
Simple abdominal radiograph reveals markedly dilated loops of the colon without rectal gas.
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Fig. 2
Barium study shows progressive tapered rectosigmoid tract (arrow) and dilated proximal sigmoid loop.
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Fig. 3
Abdominal computed tomography shows the 'whirl sign' (arrow) caused by torsion of the sigmoid mesentery.
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Fig. 4
Colonoscopy shows abnormal mucosal fold (A), luminal tapering from the rectosigmoid junction and counterclock-wise colon (B).
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Fig. 5
Photography shows markedly dilated and long sigmoid and abnormal mesocolon.
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References
1. Bruusgaard C. Volvulus of the sigmoid colon and its treatment. Surgery 1947;22:466–478.
2. Smith SD, Golladay ES, Wagner C, Seibert JJ. Sigmoid volvulus in childhood. South Med J 1990;83:778–781.
3. Arnold GJ, Nance FC. Volvulus of the colon. Ann Surg 1973;177:527–537.
4. Theuer C, Cheadle WG. Volvulus of the colon. Am Surg 1991;57:145–150.
5. Morrissey TB, Deitch EA. Recurrence of the sigmoid volvulus after surgical intervention. Am Surg 1994;60:329–331.
6. Werkin MG, Aufses AH Jr. Management of volvulus of the colon. Dis Colon Rectum 1978;21:40–45.
7. Lee HK, Choi SJN. Chronic constipation led to sigmoid volvulus in a child. J Korean Surg Soc 2009;77:441–444.
8. Cook ES, Allison EJ Jr. Sigmoid volvulus in a young patient. Ann Emerg Med 1984;13:963–966.
9. Ismail A. Recurrent colonic volvulus in children. J Pediatr Surg 1997;32:1739–1742.
10. Puneet, Khanna R, Gangopadhyay AN, Shahoo SP, Khanna AK. Sigmoid volvulus in childhood: report of six cases. Pediatr Surg Int 2000;16:132–133.
11. Carter R, Hinshaw DB. Acute sigmoid volvulus in children. Am J Dis Child 1961;101:631–634.
12. Salas S, Angel CA, Salas N, Murillo C, Swischuk L. Sigmoid volvulus in children and adolescents. J Am Coll Surg 2000;190:717–723.
13. Kim JH, Kim JY, Kwon KA, Chung MG, Yeon JE, Park JJ, et al. Clinical analysis of sigmoid volvulus. Intest Res 2005;3:117–120.
14. Gibney EJ. Volvulus of the sigmoid colon. Surg Gynecol Obstet 1991;173:243–255.
15. Renzulli P, Maurer CA, Netzer P, Büchler MW. Preoperative colonoscopic derotation is beneficial in acute colonic volvulus. Dig Surg 2002;19:223–229.
16. Brothers TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg 1987;206:1–4.