Colonic volvulus in children: Surgical management of a challenging condition

Abstract

Colonic volvulus (CV) is a rare but potentially life‐threatening condition with unclear etiopathogenesis. To date, less than 80 pediatric cases have been described. Hirschsprung’s disease (HD) is associated with CV in 17% of cases, representing a significant risk factor. Non‐HD CV is an even more complex entity. The aim of this study is to describe a series of patients with CV to ac-centuate some peculiar aspects of this disease. We performed a retrospective study (period: 2012–2021) collecting information of patients with CV. Data analyzed included: demographics, medical history, presenting symptoms and radiological and surgical details. Eleven patients (12.5 ± 2.8 years; 7F/4M) had CV (eight sigmoid, two transverse colon, one total colon). Five patients had associated anomalies and three had HD. A two‐step approach with volvulus endoscop-ic/radiological detorsion followed by intestinal resection was attempted in eight cases (one endoscopic approach failed). Three patients required surgery at admission. At follow‐up, two patients developed recurrent intestinal obstruction, one of whom also had anastomotic stenosis. Colonic volvulus is a challenging condition that requires prompt patient care. A missed diagnosis could lead to severe complications. The evaluation of the patient should include a careful histological examination (searching for HD and alpha‐actin deficiency), immunologic and metabolic screening, neurological tests and detection of chronic intestinal pseudo‐obstruction (CIPO). Lifelong fol-low‐up is mandatory for the early recognition and treatment of progressive diseases involving the proximal gastrointestinal tract.