Purpose or Case Report: Colonic volvulus in the pediatric population is very rare with 40% mortality making timely diagnosis imperative. Radiologists should operate with a high degree of clinical suspicion in patients with risk factors for large bowel volvulus. Recognition of colonic volvulus on plain film, contrast enema and CT is paramount to work-up and definitive management. This case series is the largest from any single institution and describes the clinical course and imaging findings in cases of volvulus, with the goal of familiarizing the radiologist with the appearance of this disease entity on several imaging modalities.
Methods & Materials: An IRB-approved 10-year retrospective review of 11 pediatric patients with colonic volvulus was done. Imaging findings suggestive of volvulus in each case were identified, including featureless or dilated colon on plain film, lack of contrast passage on enema and beaked colon or twisting of mesocolon on CT. Imaging results were correlated with initial clinical presentation and final surgical or colonoscopic diagnosis.
Results: Eleven cases of large bowel volvulus in patients aged 3 months to 18 years were reviewed. Five had volvulus of the sigmoid, 3 of the cecum and 3 of transverse colon. Ten of 11 patients had a history of chronic constipation, 4 had prior abdominal surgeries, and 5 patients had either a neurologic condition or mental retardation limiting communication. Patients who underwent CT or contrast enema had earlier diagnosis, whereas those who received plain films required additional imaging for confirmation. Diagnosis of volvulus by imaging was reached in 6/9 patients who had plain film, 3/3 who had contrast enema and 9/9 who had CTs. Location of volvulus on CT and contrast enema corresponded with surgical or colonoscopic findings in 100% of cases, but only 22% of plain film findings were accurate for identifying the segment of colon involved in volvulus. At laparotomy, 5 out of 11 patients underwent partial colectomy of which 2 were found to have necrotic bowel. The remaining 6 had volvulus detorsion and bowel was preserved.
Conclusions: Plain film is a good screening modality when clinical presentation and risk factors raise suspicion for pediatric colonic volvulus. Further imaging by contrast enema or CT should be recommended, depending on stability of the patient. Familiarity with imaging findings of large bowel volvulus can improve detection of this disease entity, aiding in timely management of these patients.