Colonic volvulus in children: A single center experience

Background: Colonic volvulus is an uncommon cause of bowel obstruction in children. The aim of this study was to evaluate our experience in the management of children who were confirmed to have colonic volvulus at surgery. Materials and Methods: This was a retrospective study of children aged 15 years and below who were managed for volvulus of the colon over a 10 year period at the pediatric surgery unit of a tertiary hospital in Enugu, Nigeria.

Results: Over the study period, 5 cases of colonic volvulus were confirmed at surgery and managed appropriately. Four were male and one was female. The mean age of the patients was 14 years. Abdominal pain was the consistent presenting symptom in all the patients. All the patients had abdominal x-ray and abdominal ultrasound. However, abdominal x-ray was only suggestive of colonic volvulus in patients with sigmoid volvulus. Abdominal ultrasound was not diagnostic in any of the patients. Intra-operatively, three (60%) patients had sigmoid volvulus, one (20%) had cecal volvulus and there was one (20%) volvulus of the transverse colon. All the patients had resection of the involved colon. Four (80%) patients had bowel resection with primary anastomosis but one (20%) patient (with sigmoid volvulus) required a temporary colostomy. None had colonoscopy because of absence of the facility. Surgical site infection was the most common post-operative complication. There was no mortality.

Conclusion: Sigmoid volvulus is more common than cecal and transverse volvulus. Imaging investigation may be helpful in making a diagnosis; however, confirmation can only be made at surgery. A high index of suspicion is required for early diagnosis and treatment.