VOLVULUS IN CHILDHOOD

Gastric volvulus or volvulus of the small-bowel can occasionally be fo und in neonates and small infants. Since volvulus is an emergency case , the radiologist must know the characteristic radiological findings a nd the ultrasound signs in correlation to the clinical symptoms. Two f orms of gastric volvulus can be distinguished: the organoaxial type an d a mesenterioaxial form. Besides an idiopathic etiology, diaphragmati c alterations can be observed in children with volvulus of the stomach . Volvulus of the small-bowel occurs in children with malrotation type I or II or with nonrotation. Bile-stained vomiting starts within the first days of life and is followed by the clinical signs of high bower obstruction and peritonitis. Primarily in cases of gastric volvulus, an ultrasound examination can show the wrong position of the stomach o r the pyloric region. In cases of small-bowel volvulus, abnormal local ization of the superior mesenteric artery can be demonstrated. The pla in film features an upper small-bowel obstruction. Upper intestinal co ntrast studies may reveal the level of small-intestine obstruction. a contrast enema can rule out a concomitant colon nonrotation or malrota tion. A rare form which can be misdiagnosed easily, is volvulus of the sigmoid with pathological elongation and positioning of the sigma. It appears mostly in school children with less urgent symptoms and can d isappear spontaneously. A typical feature is pain in the left lower ab domen acid complete obstruction in an opaque enema.