title: Neonatal sigmoid volvulus.
abstract: BACKGROUND
  Neonatal sigmoid volvulus is a rare entity. It is associated with Hirschsprung's disease. Presentation is acute abdominal distention, vomiting and obstipation. Abdominal radiograph will show the "coffee bean" sign, but this is frequently missed and the diagnosis requires a high index of suspicion. Treatment options include contrast enema, colonoscopy or laparotomy, depending on the condition of the baby and local availability.
  
  
  RESULTS
  During the last 6years, 6 infants with sigmoid volvulus were treated in our department. Four presented during the first 48h since birth, and 2 presented at the age of 2 and 7weeks of age. One child was operated and 5 had primary contrast enema with radiologic de-volvulus. Rectal biopsy was performed in all cases; three children had Hirschsprung's disease. Those with normal biopsies responded well to rectal washouts. Two patients had early one stage transanal pullthrough and one had 2 further occasions of sigmoid volvulus prior to definitive surgery. All three recovered with an uneventful course.
  
  
  CONCLUSIONS
  Neonatal sigmoid volvulus requires a high level of suspicion. Contrast enema is efficient for primary de-volvulus. Rectal biopsy should be performed and if positive for Hirschsprung's disease, surgery should be performed sooner rather than later.
authors.affiliation: Department of General Surgery, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Harbi
authors.initials: H
authors.lastname: Khalayleh
authors.affiliation: Department of Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Koplewitz
authors.affiliation: Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Vadim
authors.initials: V
authors.lastname: Kapuller
authors.affiliation: Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Armon
authors.affiliation: Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Sinan
authors.initials: S
authors.lastname: Abu-Leil
authors.affiliation: Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: arbell@hadassah.org.il.
authors.forename: Dan
authors.initials: D
authors.lastname: Arbell
mesh_terms: D001706:Biopsy; D003113:Colonoscopy; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007813:Laparotomy; D008297:Male; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Contrast enema; Hirschsprung's disease; Neonate; Sigmoid volvulus