Royal Manchester Children's University Hospital, Manchester, United Kingdom.
J Pediatr Surg. 2012 Aug;47(8):1572-5. doi: 10.1016/j.jpedsurg.2011.10.064.
Proximal large bowel volvulus is considered as an extremely rare surgical emergency in children. Approximately 40 cases have been reported, and because of its rarity, the diagnosis is often missed or delayed. The purpose of this study was to review the presentation, treatment, and clinical outcome of proximal large bowel volvulus.
A systematic review and analysis of the data relating to 6 patients from the author's practice and cases published in the English literature from 1965 to 2010 was performed. Detailed information regarding demographics, clinical presentation and methods of diagnosis, surgical procedure, complications, and outcome were recorded.
Thirty-six cases of proximal large bowel volvulus were retrieved from the English literature, and 6 cases, from the author's practice. The male-female ratio was 1:1, with a median age of 10 years. There were 29 (69%) cases with neurodevelopmental delay. Clinical presentation included 29 (69%) cases with constipation, 41 (98%) with colicky abdominal pain, 42 (100%) with abdominal distension, and 35 (83%) with vomiting. Plain radiography was specific in 64% (27/42) of cases, barium enema in 100% (15/15), and computed tomography in 100% (2/2). All patients underwent surgery, with resection and primary anastomosis in 24 (57%) cases, stoma formation in 11 (26%), and detorsion of volvulus without resection in 7 (17%) cases. Six patients (14%) died postoperatively.
A child with neurodevelopmental delay and a history of constipation presenting with an acute onset of colicky abdominal pain and progressive abdominal distension with vomiting should be suspected of having a cecal and proximal large bowel volvulus.
近端大肠扭转被认为是儿童中一种极其罕见的外科急症。大约有 40 例报告病例，由于其罕见性，诊断常常被忽视或延迟。本研究旨在回顾近端大肠扭转的表现、治疗和临床结果。
对作者实践中 6 例患者和 1965 年至 2010 年发表的英文文献中报道的病例进行了系统回顾和数据分析。记录了人口统计学、临床表现和诊断方法、手术过程、并发症和结果的详细信息。
从英文文献中检索到 36 例近端大肠扭转病例，从作者实践中检索到 6 例。男女比例为 1:1，中位年龄为 10 岁。有 29 例（69%）有神经发育迟缓。临床表现包括 29 例（69%）便秘，41 例（98%）腹痛绞痛，42 例（100%）腹胀，35 例（83%）呕吐。平片在 64%（27/42）的病例中具有特异性，钡灌肠在 100%（15/15）的病例中具有特异性，计算机断层扫描在 100%（2/2）的病例中具有特异性。所有患者均接受手术治疗，其中 24 例（57%）行切除和一期吻合术，11 例（26%）行造口术，7 例（17%）行扭转复位而无需切除。6 例患者（14%）术后死亡。
对于有神经发育迟缓病史且有便秘史的儿童，出现急性腹痛绞痛和进行性腹胀伴呕吐，应怀疑有盲肠和近端大肠扭转。
