Sigmoid colon volvulus in children: review of 19 cases

Abstract

The records of 19 patients with sigmoid colon volvulus (SCV) who were treated surgically in a 36.5-year-period were reviewed. Seven of them (37 %) had ileosigmoidal knotting (ISK). The age range was between 10 weeks and 17 years (mean 10 years), and 17 patients (90%) were male. In two cases (11%) there was previous SCV history. The mean symptom duration was 57 h (range 24-96), and three patients (16%) were in shock. The main symptoms were abdominal pain (90%), distention (79%), vomiting (74%), and obstipation (58%), and the main signs were abdominal tenderness (90%), distention (79%), absence of stool in the rectum and hypo- or akinetic bowel sounds (58%), muscular rigidity (53%), hyperkinetic bowel sounds (32%), and melanotic stool in the rectum (21%). The torsion was found in a clockwise direction in 47%, and the torsion degree was 360 in 42%. In four patients (21%) there was no gangrene (one with ISK), whereas in 15 (79%) sigmoid colon was gangrenous (six with ISK, in whom small bowel was also gangrenous). In nongangrenous cases, detorsion (11%) or sigmoidopexy (11%) was performed. In gangrenous cases, gangrenous sigmoid colon was resected, and Hartmann's procedure (74%) or primary anastomosis (5%) was performed. In those with associated gangrene of the small bowel, resection and enteroenteric anastomosis were done. Four patients (21%) died, with the most common cause of death being toxic shock. In 11 patients, including five with SCV and six with ISK, no recurrence was seen in a mean 18-year follow-up period (range 8-39). As a result, preoperative resuscitation, prompt surgery, and postoperative support are important in emergent SCV in children.