Volvulus of the Sigmoid Colon By D, C. Keramidas, C. Skondras, D. Anagnostou, and N. Voyatzis Athens, Greece 9 Sigmoid volvulus in children is quite occur in an acute fulminating form requiring and surgery. In this case, bowel continuity of the necrotic sigmoid was reestablished operation.
rare and may early diagnosis after resection in a two-stage
INDEX WORDS: Sigmoid volvulus: sigmoidectomy.
CASE REPORT A well-developed male aged 8 yr, was admitted complaining of colicky abdominal pain and vomiting of 16-hr duration. His past history and family history were negative. No previous gastrointestinal disturbance was reported. On physical examination, the abdomen was distended and tender with guarding in the left lower quadrant. Bowel sounds were hyperactive. The rectal content was a mixture of a mucus with dark blood. The patient was dehydrated. The blood pressure was moderately below normal, and the cardiac and respiratory
S Fig. 2, Volvulus of the sigmoid. Redundancy, distention, and ischemia of the colon are noted.
rate were above normal, and the temperature was 37.4~ The WBC was 15.000 with 79% polymorphs. A plain radiogram in the upright position showed a dilated colonic loop in the upper abdomen and absence of gas in the lower part of the abdomen (Fig. 1). Laparotomy through a right paramedian incision revealed a volvulus of the sigmoid colon. The sigmoid appeared redundant, distended, and ischemic with necrotic areas (Fig. 2). The arterial supply of the mesosigmoid was occluded. The vascularity of the descending colon was also impaired up to the splenic flexure. The peritoneal cavity contained 400 cc of fluid. The sigmoid colon was rotated to its normal position and sigmoidectomy was performed. Anastomosis of the descending colon with the rectum could not be readily accomplished because of the poor vascularity and edema. The rectal stump was closed and a left lower quadrant colostomy was established by using the cut-end of the descending colon. The patient made a good recovery. On the 45th postoperative day continuity of the bowel was reestablished. The postoperative course was uneventful. One year after the two-stage procedure bowel function and barium enema were found to be normal.
DISCUSSION
Volvulus of the sigmoid colon is rare in childhood, but the true incidence is unknown. It is more common in males) 3 Redundancy of the
Fig. 1. Plain radiogram of the abdomen showing a dilated colonic loop above the descending colon and absence of gas in the lower part of the abdomen.
Journal of Pediatric Surgery, Vol. 14, No. 4 (August), 1979
From the Department of Surgery, Children's Hospital A.P. Kyriakou, Athens, Greece. Address reprint requests to Dr. D. C. Keramidas, Children's Hospital A. P. Kyriakou, Athens 608, Greece.
rare and may early diagnosis after resection in a two-stage
INDEX WORDS: Sigmoid volvulus: sigmoidectomy.
CASE REPORT A well-developed male aged 8 yr, was admitted complaining of colicky abdominal pain and vomiting of 16-hr duration. His past history and family history were negative. No previous gastrointestinal disturbance was reported. On physical examination, the abdomen was distended and tender with guarding in the left lower quadrant. Bowel sounds were hyperactive. The rectal content was a mixture of a mucus with dark blood. The patient was dehydrated. The blood pressure was moderately below normal, and the cardiac and respiratory
S Fig. 2, Volvulus of the sigmoid. Redundancy, distention, and ischemia of the colon are noted.
rate were above normal, and the temperature was 37.4~ The WBC was 15.000 with 79% polymorphs. A plain radiogram in the upright position showed a dilated colonic loop in the upper abdomen and absence of gas in the lower part of the abdomen (Fig. 1). Laparotomy through a right paramedian incision revealed a volvulus of the sigmoid colon. The sigmoid appeared redundant, distended, and ischemic with necrotic areas (Fig. 2). The arterial supply of the mesosigmoid was occluded. The vascularity of the descending colon was also impaired up to the splenic flexure. The peritoneal cavity contained 400 cc of fluid. The sigmoid colon was rotated to its normal position and sigmoidectomy was performed. Anastomosis of the descending colon with the rectum could not be readily accomplished because of the poor vascularity and edema. The rectal stump was closed and a left lower quadrant colostomy was established by using the cut-end of the descending colon. The patient made a good recovery. On the 45th postoperative day continuity of the bowel was reestablished. The postoperative course was uneventful. One year after the two-stage procedure bowel function and barium enema were found to be normal.
DISCUSSION
Volvulus of the sigmoid colon is rare in childhood, but the true incidence is unknown. It is more common in males) 3 Redundancy of the
Fig. 1. Plain radiogram of the abdomen showing a dilated colonic loop above the descending colon and absence of gas in the lower part of the abdomen.
Journal of Pediatric Surgery, Vol. 14, No. 4 (August), 1979
From the Department of Surgery, Children's Hospital A.P. Kyriakou, Athens, Greece. Address reprint requests to Dr. D. C. Keramidas, Children's Hospital A. P. Kyriakou, Athens 608, Greece.
