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Pediatric colonic volvulus.

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eMediNexus    20 February 2018

A recent study published in the Journal of Pediatric Surgery presented an analysis of cases over 15 years at a single institution, focusing on workup and diagnosis of pediatric colonic volvulus. This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring from 2000 to 2015. The findings revealed that the most common presenting symptoms were abdominal pain and distention. Most of the afflicted patients had either prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Among the patients assessed, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, by CT in 55.6% of cases, and by plain radiography of the abdomen in 22.2% of cases. Colonic volvulus was confirmed by laparotomy in all cases. On the other hand, cecum was the most often affected colonic segment, followed by the sigmoid. While, operative treatment mainly consisted of resection in 63.6% and ostomy creation in 36.4%, colopexy was performed in 18.2% of cases. From the results, it was concluded that simple 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. It was stated that CT may be the most precise and useful test in diagnosis of colonic volvulus and confers an added advantage of detection of complications including bowel ischemia.

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