Childhood sigmoid volvulus

Abstract

Objectives: Childhood sigmoid volvulus (SV) is a comparatively rare illness. The objective of this study was to examine the recent advances in childhood SV.

Methodology: In clinical review conducted at Ataturk University, Turkey, we used combined retrospective (from June 1966 to July 1986) and prospective (from July 1986 to July 2026) evaluation.

Results: Fourteen children constituted 1.3% of total 1,101 SV cases. Mean age was 10.3 years (range: 10 weeks-17 years) and male/female ratio was 12/2 (85.7%/14.3%). Previous SV attack was present in two patients (14.3%). Mean admission period was 60.9 hours (range: 24-96 hours). Main clinical features were abdominal pain/tenderness (12 cases, 85.7%), distention (ten cases, 71.4%), abnormal bowel sound (nine cases, 64.3%), vomiting (seven cases, 50.0%), obstipation and muscular rigidity/rebound tenderness (six cases, 42.9% for each), hypokinetic/akinetic bowel sound and shock (four cases, 28.6% for each), and gangrenous stool (two cases, 14.3%). SV was diagnosed by abdominal X-ray radiography in seven patients (50.0%), at laparotomy in five cases (35.7%), and by computed tomography in two patients (14.3%). Emergency surgery was required in 12 cases (85.7%), while endoscopic detorsion was recently performed in two cases (14.3%) and elective surgery was added in one (7.1%). Mortality and morbidity were seen in four cases (28.6%) for each.

Conclusion: Although childhood SV is rare, it is still a critical area due to its relatively poor anamnestic inability, diagnostic difficulty, and prognostic outcome. However, diagnostic efficacy of CT, therapeutic contribution of endoscopic detorsion, and recurrence-preventive effect of elective laparoscopic surgery are important advances during the recent years.