Sigmoid volvulus in children and adolescents

Background: Sigmoid volvulus is an exceptionally rare and potentially life- threatening condition in the pediatric age group. Study Design: We report our experience with three children treated for sigm oid volvulus and review the cases reported in the medical literature since 1940. Results: Since 1940, 63 cases of sigmoid volvulus in children (including th is series) have been reported. The median age was 7 years and the male to f emale ratio was 3.5:1. Two distinct presentations (acute and recurrent) wer e identified. Abdominal symptoms dominated the clinical picture. Barium ene mas either confirmed or were highly suggestive of sigmoid volvulus. Reducti on by barium enema was successful in 77% (10 of 13) of the attempts. Forty- nine patients underwent operative treatment, with sigmoidectomy (with or wi thout primary anastomosis) being the most common. The overall mortality rat e was 6%, operative mortality was 8.1%, and neonatal mortality was 14%. Ass ociated conditions were frequent. Particular emphasis should be placed on r uling out Hirschsprung's disease (present in 11 of 63 patients). Conclusions: Sigmoid volvulus remains a rare occurrence in children, but it should be included in the differential diagnosis of pain in children when colonic distention is present. An algorithm for treatment is proposed. (J A m Coll Surg 2000;190:717-723. (C) 2000 by the American College of Surgeons) .