Volvulus in childhood

Gastric volvulus or volvulus of the small-bowel can occasionally be found in neonates and small infants. Since volvulus is an emergency case, the radiologist must know the characteristic radiological findings and the ultrasound signs in correlation to the clinical symptoms. Two forms of gastric volvulus can be distinguished: the organoaxial type and a mesenterioaxial form. Besides an idiopathic etiology, diaphragmatic alterations can be observed in children with volvulus of the stomach. Volvulus of the small-bowel occurs in children with malrotation type I or II or with nonrotation. Bile-stained vomiting starts within the first days of life and is followed by the clinical signs of high bowel obstruction and peritonitis. Primarily in cases of gastric volvulus, an ultrasound examination can show the wrong position of the stomach or the pyloric region. In cases of small-bowel volvulus, abnormal localization of the superior mesenteric artery can be demonstrated. The plain film features an upper small-bowel obstruction. Upper intestinal contrast studies may reveal the level of small-intestine obstruction. A contrast enema can rule out a concomitant colon nonrotation or malrotation. A rare form which can be misdiagnosed easily, is volvulus of the sigmoid with pathological elongation and positioning of the sigma. It appears mostly in school children with less urgent symptoms and can disappear spontaneously. A typical feature is pain in the left lower abdomen and complete obstruction in an opaque enema.