title: Pediatric colonic volvulus: A single-institution experience and review.
abstract: OBJECTIVE
  Pediatric colonic volvulus is both rare and underreported. Existing literature consists only of case reports and small series. We present an analysis of cases (n=11) over 15 years at a single institution, focusing on workup and diagnosis.
  
  
  METHODS
  This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring over 15 years (2000-2015).
  
  
  RESULTS
  In our series, the most common presenting symptoms were abdominal pain and distention. Afflicted patients often had prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Of the imaging modalities utilized in the 11 patients studied, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, CT in 55.6% of cases and by plain radiography of the abdomen in only 22.2%of cases. Colonic volvulus was confirmed by laparotomy in all cases. The cecum (n=5) was the most often affected colonic segment, followed by the sigmoid (n=3). Operative treatment mainly consisted of resection (63.6%) and ostomy creation (36.4%). Colopexy was performed in 18.2% of cases.
  
  
  CONCLUSIONS
  Plain abdominal radiography may be performed as an initial diagnostic study, however, it should be followed CT or air or contrast enema in children where there is high clinical suspicion and who do not have indications for immediate laparotomy. CT may be the most specific and useful test in diagnosis of colonic volvulus and has the added advantage of detection of complications including bowel ischemia. We demonstrate a range of diagnostic and therapeutic modalities for pediatric colonic volvulus. This underscores the need for further study to draft standard best practices for this life-threatening condition.
  
  
  METHODS
  Prognosis Study: Level IV. Study of a Diagnostic Test: Level III.
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Sami.Tannouri@Jefferson.edu.
authors.forename: Sami
authors.initials: S
authors.lastname: Tannouri
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Aditi
authors.initials: A
authors.lastname: Hendi
authors.affiliation: Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gilje
authors.affiliation: Department of Radiology, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Grissom
authors.affiliation: Department of Pediatric Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D003125:Colostomy; D005260:Female; D006801:Humans; D007223:Infant; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D011379:Prognosis; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Large bowel obstruction; Pediatric volvulus