Volvulus | Overview
What is volvulus?
Intestinal malrotation is a congenital problem, which means that it is present at birth. In this condition, the intestines don't form properly and fail to make the turns in the abdomen that they should. Intestinal malrotation can put your child at risk for serious complications. One of these is called volvulus, which occurs when the intestine twists on itself, cutting off its blood supply. This complication can cause the intestinal tissue to die.
What are the symptoms of volvulus?
Symptoms of volvulus include:
- yellow or green vomit (bilious vomiting)
- severe abdominal pain
- abdominal swelling or distention
- rapid heart rate
- rapid breathing
- bloody stools
If your child exhibits such symptoms, you should seek immediate medical evaluation and treatment.
Children with volvulus may not have long-term problems if the volvulus is repaired promptly. However, surgery is required within in hours of onset of symptoms for this to occur. Unfortunately, a large proportion of children experience intestinal injury, which requires the removal of the damaged intestine and in turn can lead to short bowel syndrome (SBS). In this condition, children lack enough intestine to properly absorb nutrients, which may require them to get hydration and nutrition through an intravenous central line and a feeding tube.
How we care for volvulus
The skilled clinicians in the Center for Advanced Intestinal Rehabilitation at Boston Children's Hospital care for children who have experienced complications from volvulus, such as SBS. Our interdisciplinary program is staffed by an experienced team of experts who take all aspects of your child's care into account. These specialists include physicians trained in surgery, gastroenterology and nutrition, registered dietitians, nurses and nurse practitioners, pharmacists and social workers.
In 2002, our doctors performed the world's first serial transverse enteroplasty procedure (STEP), a surgical technique that lengthens and tapers the intestines of children with SBS. Since then, we have performed dozens of these procedures with success. Our center is also renowned for innovations in the nutritional and medical management of children with SBS. CAIR was the first center to use a novel intravenous preparation (Omegaven) for the treatment of liver disease associated with intestinal failure.
Volvulus | Diagnosis & Treatment
How is volvulus diagnosed?
If volvulus is suspected, urgent diagnosis required. The gold standard to diagnose volvulus is an upper GI series, a procedure performed to examine the stomach and first portion of the intestine.
How is volvulus treated?
Volvulus is a life-threatening emergency that requires immediate medical attention.
Volvulus is usually surgically treated as soon as possible. The surgeon will untwist the intestine and check it for damage. If the intestine is healthy, the surgeon will place it back in the abdomen. If the health of the intestine is unclear, the surgeon may perform another operation in 24 to 48 hours to check it. If the intestine appears to be damaged, the injured section may be removed.
If a large part of the intestine has been injured, the surgeon may need to remove a significant amount of it. Doctors may perform an ostomy, in which the remaining healthy ends of intestine are placed through openings in the abdomen. Stool will pass through the opening (called a stoma).