Colonic volvulus in children with intestinal motility disorders.
BACKGROUND
Chronic intestinal pseudo-obstruction (CIP) is a condition characterized by symptoms of bowel obstruction in the absence of an anatomical cause. Patients with CIP and chronic intractable constipation (CIC) can also develop anatomical obstruction, and the presenting symptoms mimic those of underlying pseudo-obstruction.


OBJECTIVE
Our objectives were to evaluate the incidence, clinical presentation, and diagnostic investigations of colonic volvulus in children with intestinal motility disorders and to differentiate these episodes of colonic volvulus from the underlying motility disorder based on clinical presentation and imaging techniques.


METHODS
Patients records of children with colonic volvulus cared for at our institution over the previous 20 years were retrospectively reviewed. We identified 8 patients who were between 2 and 22 years of age at the time of diagnosis with colonic volvulus who also had CIP and CIC.


RESULTS
The mean age +/- SD at presentation with colonic volvulus was 13.2 +/- 5.05 years. All patients presented with worsening of abdominal distension and pain. The mean duration of symptoms of colonic volvulus before seeking medical help was 4.2 days (range 1-7 days). Water-soluble contrast enema was the single most useful investigation for confirming the diagnosis. All patients required surgery. There was no mortality associated with colonic volvulus.


CONCLUSIONS
Clinicians should be vigilant and include volvulus in the differential diagnosis of the acute onset of abdominal distension and pain in patients with CIP and CIC. Delay in diagnosis can result in bowel ischemia and perforation.
Altaf
Muhammad A
MA
Department of Pediatrics, Division of Pediatric Gastroenterology & Nutrition, Medical College of Wisconsin, and the Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
Werlin
Steven L
SL
Sato
Thomas T
TT
Rudolph
Colin D
CD
Sood
Manu R
MR
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000175:diagnosis* / Q000209:etiology; D003248:Constipation / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D005769:Gastrointestinal Motility; D006801:Humans; D015994:Incidence; D007418:Intestinal Pseudo-Obstruction / Q000150:complications* / Q000175:diagnosis; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D010146:Pain / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult