title: Diagnosis of pediatric colonic volvulus with abdominal radiography: how good are we?
abstract: BACKGROUND
  Colonic volvulus is rare in children and associated with colonic dysmotility. Diagnosis of colonic volvulus on radiographs in these patients can be challenging. The purpose of the study was to identify the accuracy of abdominal radiographs and findings suggestive of colonic volvulus.
  
  
  METHODS
  A retrospective (2003- 2014) study of all children with colonic volvulus proven surgically or endoscopically reviewed their medical charts for underlying disease and clinical presentation as well as their original radiograph reports. Two pediatric radiologists (reader 1 and reader 2) independently reviewed the radiographs. The kappa test was used to evaluate interobserver variability.
  
  
  RESULTS
  There were 19 cases of colonic volvulus in 18 patients (11 males) a mean age 14 years. Cecal volvulus was the most common finding at 14/19 cases (74%). Sixteen of 18 (89%) patients had neurological impairment and 10 of 18 (56%) had intestinal dysmotility. The most common presentation was abdominal distension (14/19 [74%]) and pain (11/19 [58%]). Colonic volvulus was diagnosed in only 7/16 (44%) of the abdominal radiographs. The specific finding of a coffee-bean sign was retrospectively observed only by reader 2 in two cases. Absence of rectal gas and focal colonic loop dilation were the most common findings by the readers (average 73.5% and 87%, respectively) with Kappa values of 0.3 and 0.38, respectively.
  
  
  CONCLUSIONS
  Diagnosis of colonic volvulus in children can be challenging. Radiologists should be alerted to the possibility of colonic volvulus when there is focal colonic loop distention or absent rectal gas.
authors.affiliation: Department of Radiology and Imaging Sciences, Riley Hospital for Children, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA. mbshelto@iupui.edu.|Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA. mbshelto@iupui.edu.
authors.forename: Megan B
authors.identifier: http://orcid.org/0000-0003-0656-3157
authors.initials: MB
authors.lastname: Marine
authors.affiliation: Department of Radiology and Imaging Sciences, Riley Hospital for Children, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA.|Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Cooper
authors.affiliation: Department of Radiology and Imaging Sciences, Riley Hospital for Children, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA.|Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Delaney
authors.affiliation: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Samuel Gregory
authors.initials: SG
authors.lastname: Jennings
authors.affiliation: Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
authors.affiliation: Department of Radiology and Imaging Sciences, Riley Hospital for Children, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA.|Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Boaz
authors.initials: B
authors.lastname: Karmazyn
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003106:Colon / Q000000981:diagnostic imaging; D003108:Colonic Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging*; D008297:Male; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
keywords: Abdomen; Children; Colon; Colonic volvulus; Intestinal dysmotility; Obstruction; Radiography