Volvulus

As volvulus is understood in medicine rotation of a portion of the digestive tract to its mesenteric axis. By the rotation of the blood supply to the affected portion of the digestive tract, which extends in the mesentery is restricted. It can be used for intestinal obstruction up to the demise of the affected section ( Darmgangrän ) come. A suspicion of an acute volvulus in childhood is therefore a pediatric surgical emergency dar.

Frequency

Most commonly it occurs in the cecum and sigmoid. In the small intestine area of ​​volvulus usually occurs as a result of malrotation.

In childhood, is found in all age groups an equal incidence, however ( gangrene) are in neonates under 30 days complications in terms of intestinal destruction frequently.

Symptoms

Prenatal volvulus

The volvulus can occur even before birth. For such a situation, then, due to the destruction of intestinal shares an intestinal atresia result.

Acute volvulus

• Expanded (upper ) abdominal
• Vomit
• Peritonitis
• Shock
• Nonspecific laboratory parameters (leukocytosis, increase of lactate, CRP, etc.)

Chronic recurrent volvulus

• Malabsorption
• Non-specific abdominal pain
• Constipation
• Symptom- free intervals

Diagnosis

The diagnosis is made on the basis of clinical and x-rays of the abdomen (possibly with contrast media), and recently also by means of ultrasound. The diagnostic process especially in the neonatal period can be difficult, because the clinic only shows a swelling of the abdomen, the X-ray image can be non-specific.

When volvulus of the sigmoid colon is found due to a massive hyperinflation of this intestinal portion often a so-called coffee beans mark ( coffee -bean sign ), in which an ascending loop is placed close to a descending, so that gives the contour of an oversized coffee bean. With already taken gehabter perforation is found in the X-ray image so called "free air ".

The diagnosis of chronic recurrent volvulus can be very difficult also because it can only be provided in an acute episode.

Most important differential diagnosis for acute volvulus is the intussusception.

Treatment

Acute volvulus

The treatment consists in the quickest possible restoration of the correct position of the corresponding intestinal segment. In cases of suspected volvulus (except Sigma - see below ), a speedy operation, since existing undersupply can be a rapid demise of this section of the digestive tract with blood. The back twisted intestine or stomach may still be fixed. Are parts already so damaged that it is not expected to restore the function, these components are removed. If necessary, you have to create a temporary enterostomy.

Special case: When a volvulus of the sigmoid without peritonitis derotation can be attempted with a carefully over the anus introduced probe and an enema. If this is not successful, it will surgery.

Chronic volvulus

Case of proven chronic volvulus may be trying to fix the affected section of the digestive tract by means of surgery.

Forecast

Specifically, in the presence of an acute Small bowel volvulus can occur to the demise of larger parts of the intestine, which can lead to short bowel syndrome with possibly life-long consequences.