Purpose or Case Report: Pediatric colonic volvulus is very rare with 40% mortality, making diagnosis time-sensitive. Surgeons rely on imaging confirmation, but sensitivity of plain film is low and contrast enema is contraindicated in patients with acute abdomen. Alternatively, CT is a safe, sensitive modality and aids in pre-operative planning. We identified 11 patients over 10 years with colonic volvulus, of which 5 are chosen to describe the role of CT in work-up.

Case 1: A 12 yo male with Prune-Belly Syndrome and prior abdominal surgery presents with a day of abdominal distention. Radiography was initially concerning for small bowel obstruction. He deteriorated and the next day CT showed necrotic, distended colon in the midline. Exploratory laparotomy 24 hours after presentation revealed volvulus and necrosis of the mid transverse colon, and partial colectomy was performed.

Case 2: A 17 yo female with cerebral palsy, mental retardation and prior abdominal surgery presents with a day of abdominal distension. Radiography was concerning for volvulus. Barium enema confirmed cecal volvulus but did not decompress the bowel. Rectal tube trial was also unsuccessful. Exploratory laparotomy 2 hours after presentation revealed 720° cecal volvulus and ileocecectomy was performed.

Case 3: A 4 yo female with chronic constipation presented with 12 hours of severe abdominal pain. Radiography was initially concerning for small bowel obstruction, but CT showed transverse colonic volvulus. Four hours after presentation, the transverse colonic volvulus was detorsed and bowel was preserved during laparotomy.

Case 4: A 10 yo male with chronic constipation presented with severe abdominal pain. Radiography was nonspecific but CT showed fecal impaction and cecal volvulus. Exploratory laparotomy six hours after presentation confirmed cecal volvulus, which was detorsed and partial cecectomy was performed.

Case 5: A 15 yo male with Goldenhar syndrome, chronic constipation and prior abdominal surgery presents with a day of severe abdominal pain. CT showed cecal volvulus, reduction of which was unsuccessful with contrast enema. During exploratory laparotomy 12 hours after presentation, a 720° cecal volvulus was detorsed and bowel was preserved.
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Conclusions: Imaging work-up of colonic volvulus depends on the clinical stability and needs of the patient. CT should be considered in patients with acute abdomen, perhaps before conservative management, as it minimizes time to diagnosis, possibly facilitating bowel preservation.