Dmytro Klymenko, Ivana Slívova, Lubomir Martínek, Peter Ihnát
Department of Pediatric Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
Department of General Surgery, University Hospital in Ostrava, Ostrava, Czech Republic.
Pediatr Gastroenterol Hepatol Nutr. 2025 Jul;28(4):224-232. doi: 10.5223/pghn.2025.28.4.224. Epub 2025 Jul 7.
Sigmoid volvulus rarely causes bowel obstruction in children. Early diagnosis and treatment are critical for preventing complications such as bowel ischemia and peritonitis. This study aimed to develop a structured diagnostic and treatment algorithm for sigmoid volvulus in pediatric patients.
Two clinical cases of pediatric sigmoid volvulus were reviewed, focusing on the clinical presentation, diagnosis, and surgical treatment. These findings were compared with those in the literature to establish evidence-based recommendations.
Sigmoid volvulus should be considered in children who present with abdominal pain and signs of intestinal obstruction. The initial diagnosis can be made using abdominal radiography with computed tomography scans, if necessary. Colonoscopy with endoscopic detorsion of the volvulus is recommended in the absence of peritonitis. Owing to the high risk of recurrence, early resection of the sigmoid colon is recommended. Rectal biopsy is a key component of the diagnostic algorithm as it helps to confirm or exclude Hirschsprung's disease. Acute surgical intervention is indicated in children with clinical signs of peritonitis and/or pneumoperitoneum. Resection of the affected sigmoid bowel with or without primary anastomosis is recommended. Indocyanine green fluorescence imaging is a promising method for objectively evaluating bowel viability when viability is uncertain.
The proposed diagnostic and therapeutic algorithm offers a clear approach for managing sigmoid volvuli in pediatric patients.
乙状结肠扭转在儿童中很少引起肠梗阻。早期诊断和治疗对于预防诸如肠缺血和腹膜炎等并发症至关重要。本研究旨在为儿科患者的乙状结肠扭转制定一种结构化的诊断和治疗算法。
回顾了两例儿科乙状结肠扭转的临床病例，重点关注临床表现、诊断和手术治疗。将这些发现与文献中的发现进行比较，以建立循证推荐。
对于出现腹痛和肠梗阻体征的儿童应考虑乙状结肠扭转。如有必要，可通过腹部X线摄影及计算机断层扫描进行初步诊断。在无腹膜炎的情况下，建议行结肠镜检查并进行内镜下扭转复位。由于复发风险高，建议早期切除乙状结肠。直肠活检是诊断算法的关键组成部分，因为它有助于确认或排除先天性巨结肠。对于有腹膜炎和/或气腹临床体征的儿童，需进行急诊手术干预。建议切除受累的乙状结肠肠段，可选择一期吻合或不进行一期吻合。当肠管活力不确定时，吲哚菁绿荧光成像技术是客观评估肠管活力的一种有前景的方法。
所提出的诊断和治疗算法为管理儿科患者的乙状结肠扭转提供了一种清晰的方法。
