Introduction Intestinal volvulus can cause potentially fatal bowel ischaemia and/or obstruction. Diagnosis can be difficult and easily missed. Presenting symptoms are variable and there are no published studies describing the clinical presentation in children. Earlier diagnosis may reduce morbidity and mortality. Malrotation is a common underlying cause of volvulus and can be asymptomatic, or present with varied gastrointestinal symptoms at all ages[i].
Aims To describe our experience over 15 years of the presenting symptoms, age and past history of children presenting with volvulus.
Methods This study is based on a case notes review of: All children on the gastroenterology data base presenting with volvulus over the past 15 years.
Results 30 cases were reviewed. The age at presentation was variable with 24/30 (80%) presenting by 11 years, leaving a significant minority not presenting until adolescence. The majority of children (90%) presented with vomiting but in a third of cases it was non-bilious. Only 6/30 (20%) of children presented with all the classic symptoms and signs of volvulus: bilious vomiting, abdominal pain, abdominal distension, and constipation. The majority of children (18/30) had a past history of recurrent abdominal pain for which medical attention had been sought. 11/30 (37%) had a past history of unexplained vomiting and 8/30 (27%) had previous isolated nausea. The minority of children (6/30) had no gastrointestinal symptoms prior to their acute presentation with volvulus.
Conclusion Presenting features of acute volvulus are variable and can be confusing. An awareness of the possibility that symptoms and signs may not be classic could be life saving for children and prevent a tragic missed diagnosis. Malrotation is a possible cause of highly non-specific symptoms and should remain part of the differential diagnosis in patients for whom a clear cause of chronic gastrointestinal symptoms cannot be identified.
NehraD, Goldstein AM. Intestinal malrotation: varied clinical presentation from infancy through adulthood Surgery 2011 Mar: 149(3):386–93
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