3563 Enodoscopic reduction of colonic volvulus in pediatric patients.

Abstract

Colonic volvulus (CV) typically involves the cecum or sigmoid colon and is most likely to occur in the geriatric population. Risk factors include chronic constipation, megacolon and inactivity. Endoscopic reduction of CV is a well-accepted treatment in such patients.We report two adolescents (both age 13 years) with CV. Each had a history of megacolon and presented with abdominal distention and pain. In both cases the CV was reduced by colonoscopy during conscious sedation. One case involved the cecum; the other involved sigmoid colon. Case 1: A boy with a history of extensive cervical spinal fusion developed severe abdominal pain and distention with obstructive pattern by plain film radiograph. Emergent laparotomy was aborted due to an inability to intubate the airway secondary to his to a fixed cervical spine. Gastrograffin enema proved, but failed to reduce, a CV involving the cecum. Colonoscopy to the right colon ended in an abruptly narrowed twisted colonic lumen. A counterclockwise torque, air and gentle pressure were applied to the leading edge of the twisted lumen. The sudden appearance of cecal landmarks indicated reduction of the CV. He has had no recurrence in the 4 years since. Case 2. A young lady with advanced constipation and spinal dysraphism underwent Malone procedure (appendico-cutaneous fistula) to manage constipation by proximal colonic lavage. Her recovery from the procedure was unremarkable until postoperative day 9 when she developed exquisite and unremitting left lower quadrant pain, abdominal distention and radiographic evidence for distal colonic obstruction. Emergent colonoscopy revealed the odd and twisted-lumen appearance of CV at the sigmoid turn. The above endoscopic technique (torque, air, and gentle pressure) was applied. Reduction was associated with immediate relief of pain and distention and was also productive of a massive volume of watery stool. Previously unreported in the pediatric population, these cases illustrate the need to consider CV in the differential diagnosis of acute abdominal pain and distention in the child whose history includes chronic constipation, spinal anomaly and megacolon.