II. Definitions
-
Volvulus
- Twisting of intestinal loop around attachment to mesentery
- Can occur at Stomach (Gastric Volvulus), Small Intestine, cecum, transverse colon or sigmoid colon
- Midgut Volvulus (Malrotation with Volvulus)
- Associated with Intestinal Malrotation
- Presents in infants in 90% of cases
III. Epidemiology
- Malrotation with Volvulus often presents in first few weeks of life (60% present in first year of life)
IV. Symptoms: Midgut Volvulus (infants and children)
- Infants
- Bilious Emesis
- Sudden onset of Abdominal Pain
- May present with Failure to Thrive and "reflux"
- Older children
- Chronic intermittent Vomiting and abdominal cramping
- Failure to Thrive
- Constipation
- Bloody Diarrhea
V. Signs
- Abdominal exam may be benign
- Abdominal Distention is often a late finding in acute Volvulus
-
Heme positive stool
- Late sign suggesting infarcted bowel
VI. Differential Diagnosis
- See Abdominal Pain Causes
VII. Imaging
- Acute Midgut Volvulus (children): Abdominal Xray
- Often non-specific
- Dilated Stomach and proximal duodenum with intervening pylorus (Double Bubble Sign)
- Double-Bubble is also seen in Duodenal Atresia (typically diagnosed in newborn nursery)
VIII. Complications
- Intestinal infarction (high mortality)
IX. Management
- Acute stabilization
- ABC Management
- Fluid Resuscitation
- Correct Electrolyte abnormalities
- Broad spectrum Antibiotics for peritonitis
- Nasogastric Tube decompression
- Emergent surgical management
- Mesenteric Infarction and necrosis starts within first 3 hours of onset
- Necrotic bowel resected if needed
- Ladd Procedure reduces the Volvulus
- Bowel rotated counter-clockwise
- Mesenteric bands (Ladd Bands) are divided
- Small Bowel placed on the right side of Abdomen
- Large Bowel placed on the left side of Abdomen
- Appendectomy
- Widens mesenteric pedicle and reduces risk of Volvulus recurrence (but does not correct malrotation)
X. Resources
- Hebra (2012) Intestinal Volvulus, Medscape
XI. References
- Jones (2022) Crit Dec Emerg Med 36(2): 14-5
- Lampl (2012) Pediatr Radiol 39:359-66 [PubMed]
- Laurence (2012) Pediatr Emerg Care 28(1): 87-9 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A congenital abnormality in which the intestine is abnormally rotated (twisted). It may result in intestinal obstruction. |
Concepts | Congenital Abnormality (T019) |
MSH | C562456 |
SnomedCT | 29980002, 204756000, 48641006 |
English | Incomplete rotation intestine, Volvulus neonatorum, Volvulus of midgut, VOLVULUS OF MIDGUT, Malrotation of the gut, Malrotation of gut, intestinal malrotation, intestinal malrotation (diagnosis), Gut malrotation, Congenital malrotation of intestine, congenital malrotation, intestine malrotation, midgut volvulus, intestines malrotation, volvulus neonatorum, malrotation intestine, Intestinal Malrotation, Volvulus Of Midgut, Malrotation of bowel, Congenital Malrotation of Intestine, Malrotation of intestine, Incomplete rotation of intestine, Congenital malrotation (morphologic abnormality), Congenital malrotation of intestine (disorder), Congenital malrotation, bowel; malrotation, malrotation; bowel, Congenital malrotation, NOS, Intestinal malrotation |
Dutch | malrotatie van darmen, darm; malrotatie, malrotatie; darm |
French | Anomalie de la rotation intestinale |
Italian | Malrotazione intestinale |
Portuguese | Má rotação intestinal |
Spanish | Malrotación intestinal, malrotación congénita del intestino (trastorno), malrotación congénita del intestino, rotación anómala congénita de intestino (trastorno), rotación anómala congénita de intestino, rotación patológica de origen congénito (anomalía morfológica), rotación patológica de origen congénito |
Japanese | 腸回転異常, チョウカイテンイジョウ |
Czech | Abnormální rotace sttřev |
Hungarian | Intestinalis malrotatio |
German | Malrotation |
Ontology: Volvulus of the small bowel (C0238199)
Concepts | Pathologic Function (T046) |
SnomedCT | 197058003 |
Dutch | volvulus van dunne darm |
French | Volvulus de l'intestin grêle |
German | Volvulus des Duenndarms |
Italian | Volvolo dell'intestino tenue |
Portuguese | Vólvulo do intestino delgado |
Spanish | Vólvulo de intestino delgado, vólvulo del intestino delgado (trastorno), vólvulo del intestino delgado |
Japanese | 小腸捻転, ショウチョウネンテン |
English | small intestine volvulus, small intestine volvulus (diagnosis), small bowel volvulus, volvulus of the small bowel, Volvulus of small intestine, Volvulus of the small bowel, Volvulus of the small bowel (disorder), Volvulus of small bowel |
Czech | Volvulus tenkého střeva |
Hungarian | Vékonybél volvulusa |
Ontology: Volvulus of duodenum (C0267354)
Concepts | Disease or Syndrome (T047) |
ICD10 | K31.5 |
SnomedCT | 79812002 |
English | duodenal volvulus, duodenal volvulus (diagnosis), Volvulus of duodenum, Duodenal volvulus, Volvulus of duodenum (disorder) |
Spanish | vólvulo de duodeno (trastorno), vólvulo de duodeno |
Ontology: Congenital volvulus (C0345252)
Concepts | Congenital Abnormality (T019) |
SnomedCT | 204768009, 253786009 |
English | congenital volvulus, congenital volvulus (diagnosis), Congenital volvulus, Congenital volvulus (disorder), congenital; volvulus, volvulus; congenital |
Dutch | congenitaal; volvulus, volvulus; congenitaal |
Spanish | vólvulo congénito (trastorno), vólvulo congénito |