Sigmoid volvulus in children.

Volvulus of the sigmoid colon is rare in children. The authors have reviewed a total of 29 cases, including five from our institution. The most common clinical picture is crampy abdominal pain and abdominal distention. In contrast to adults, in children plain abdominal films will often not yield a diagnosis. Barium enema examination can be done to locate the obstruction. Nonoperative reduction was successful in 27 per cent of all reported cases, while operative treatment was necessary in 69 per cent of pediatric patients reported. Recurrence following derotation by any means was rare. However, adequate long-time follow-up is lacking. From available data, it seems that in most cases resection is not necessary. Primary resection may be indicated for recurrence or if the bowel is compromised. Mortality was 14 per cent, occurring in poor risk patients, the very young, and patients with associated anomalies. A redundant sigmoid may undergo intermittent torsion over a period of years, making diagnosis difficult. At laparotomy, these patients have scarred striae on the sigmoid mesocolon.