Miller Stephen,  Scrugham Jeffrey

Final Pr. ID: Poster #: EDU-108

Colonic volvulus is an uncommon but often catastrophic condition in children. Imaging studies including plain radiographs, ultrasound, fluoroscopy, and computed tomography are commonly employed to evaluate these patients. While most radiologists are familiar with malrotation and midgut volvulus, colonic volvulus is an underappreciated cause of an acute abdomen in children. Symptoms of colonic volvulus may be vague, and presentation is often delayed. While plain radiographs may be highly suggestive in some patients, they are often nonspecific. Fluoroscopy and CT are usually diagnostic and can direct appropriate operative management. The purpose of this exhibit is to present the imaging appearances of cecal and sigmoid volvulus in children, emphasizing the plain radiographic features suggestive of these entities and the diagnostic fluoroscopic and CT features that allow definitive diagnosis. Read More

Authors:  Miller Stephen , Scrugham Jeffrey

Keywords:  Volvulus, Sigmoid, Cecal

Hendi Aditi,  Harty Mary,  Grissom Leslie

Final Pr. ID: Poster #: SCI-061

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. Read More

Authors:  Hendi Aditi , Harty Mary , Grissom Leslie

Keywords:  Colonic Volvulus, Pediatric, Large Bowel Volvulus, Colonic Obstruction, Acute Abdomen

Hayatghaibi Shireen,  Sher Andrew,  Varghese Varsha,  Sammer Marla,  Bales Brandy,  Cano Melissa,  Nguyen Haithuy

Final Pr. ID: Paper #: 081

While a definitive conclusion regarding the optimal diagnostic strategy for midgut volvulus remains elusive, value can also be derived from cost. The purpose is to quantify and compare the monetary and time costs, from a provider perspective of imaging with Upper GI (UGI) versus Ultrasound (US) of children with suspected midgut volvulus. Read More

Authors:  Hayatghaibi Shireen , Sher Andrew , Varghese Varsha , Sammer Marla , Bales Brandy , Cano Melissa , Nguyen Haithuy

Keywords:  cost, volvulus, value

Nguyen Haithuy,  Guillerman R,  Orth Robert,  Seghers Victor,  Bales Brandy,  Sammer Marla

Final Pr. ID: Paper #: 126

Rapid detection and accurate diagnosis of midgut volvulus are crucial due to the risk of bowel infarction with delayed diagnosis. The purpose of our study is to evaluate the diagnostic accuracy of abdominal ultrasound (US) for midgut volvulus in the clinical setting of multiple sonographers and radiologists. Read More

Authors:  Nguyen Haithuy , Guillerman R , Orth Robert , Seghers Victor , Bales Brandy , Sammer Marla

Keywords:  Midgut volvulus, Malrotation, bowel

Lambert Elena,  Andronikou Savvas

Final Pr. ID: Poster #: EDU-036

Background:
Malrotation is an important diagnosis that needs to be identified on routine imaging and in the emergency setting. In our institution it is always surgically corrected and therefore accurate diagnosis is essential. Current teaching, supported by research, states that a lateral view on an upper gastrointestinal contrast study (UGIS) can satisfactorily demonstrate normal anatomy and a diagnosis of malrotation. The diagnosis must be made with confidence in this position because any delay in turning the patient into the AP plane can result in contrast progressing into the jejunum with overlapping bowel loops compromising the diagnosis.
Read More

Authors:  Lambert Elena , Andronikou Savvas

Keywords:  Malrotation, Midgut volvulus

Youssfi Mostafa,  Biyyam Deepa,  Bailey Smita

Final Pr. ID: Poster #: SCI-017

To share these uncommon but important cases of Midgut Volvulus (MGV) without malrotation. Read More

Authors:  Youssfi Mostafa , Biyyam Deepa , Bailey Smita

Keywords:  VOLVULUS, MALROTATION, SMA CUT-OFF

Hendi Aditi,  Harty Mary,  Grissom Leslie

Final Pr. ID: Poster #: CR-050

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. Read More

Authors:  Hendi Aditi , Harty Mary , Grissom Leslie

Keywords:  Colonic Volvulus, CT, Large Bowel Volvulus, Pediatric

Goldman-yassen Adam,  Kurian Jessica,  Blumfield Einat,  Levin Terry

Final Pr. ID: Poster #: EDU-018

Common causes of bowel obstruction (BO) in infants and children include appendicitis, adhesions, intussusception, inguinal hernia, midgut volvulus, and Meckel's diverticulum, for which the mnemonic "AIM” is used. We present uncommon causes of BO in infants and children and review the clinical presentation, imaging findings, and surgical diagnoses. Read More

Authors:  Goldman-yassen Adam , Kurian Jessica , Blumfield Einat , Levin Terry

Keywords:  Obstruction, Volvulus

Sundaram Karthik,  Singh Sudha,  Hernanz-schulman Marta

Final Pr. ID: Poster #: EDU-027

Introduction

Torsion or volvulus of upper abdominal viscera is rare and related to incomplete development and laxity of suspensory ligaments, or to poorly developed supernumerary accessory lobes. Clinical symptoms at presentation can be confusing and nonspecific, yet prompt recognition is essential to avoid life-threatening complications. Radiologists play an essential role in prompt recognition of these conditions. Our exhibit will review congenital anomalies of upper abdominal solid viscera that can lead to volvulus within an embryologic and anatomic framework. As examples, we include cases of mesenteroaxial gastric volvulus (Figure 1), torsion of an accessory hepatic lobe (Figure 2), and splenic torsion in the setting of polysplenia (Figure 3). Our cases include radiologic-pathologic correlations and therapeutic implications of solid visceral torsions.

Table of Contents/Outline:

Review of the embryology and anatomy of upper abdominal organs including a detailed pictorial of suspensory and anchoring ligaments.
Review and examples of types of gastric volvulus and treatment.

Review of variants of liver anatomy and of incidence and location of accessory hepatic lobes, with examples.

Review of splenic anatomy and normal variants, splenic torsion and gross malformations including variants seen in heterotaxy, with review of treatment options in splenic torsion, including observation, surgical pexy or resection.

Review of associated congenital anomalies (e.g. omphalocele, diaphragmatic hernia, and malrotation, etc.) Read More

Authors:  Sundaram Karthik , Singh Sudha , Hernanz-schulman Marta

Keywords:  Torsion, Volvulus, Abdominal

Panesar Harsimran,  Beekman Alexander,  Martin Laura,  Armstrong Katherine,  Hodes Aaron

Final Pr. ID: Poster #: CR-006

Midgut volvulus in children is uncommon, but diagnosis of portal vein thrombosis in association with midgut volvulus has been rarely reported. We present a case of a 3-year old male with an unusual presentation of recurrent episodic abdominal pain suspected initially having ileocolic intussusception. Cross-sectional imaging identified extensive acute portomesenteric thrombosis in the setting of suspected midgut volvulus, which was confirmed on upper GI series and at surgery. A thrombophilia workup was negative. To our knowledge, this is the first case of acute portal vein and superior mesenteric vein thrombosis with splenic vein extension in association with midgut volvulus. When the diagnosis remains elusive and imaging demonstrates an extensive acute PVT with SMV extension in children and adolescents, radiologists should consider midgut volvulus in addition to other etiologies, such as malignancy, cirrhosis, or bowel inflammation. Read More

Authors:  Panesar Harsimran , Beekman Alexander , Martin Laura , Armstrong Katherine , Hodes Aaron

Keywords:  Portal vein thrombosis, Superior mesenteric vein thrombosis, Midgut volvulus