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    Volvulus - childhood

    Childhood volvulus; Abdominal pain - volvulus; Sigmoid volvulus; Cecal volvulus; Acute colonic pseudo-obstruction (ACPO)

    A volvulus is a twisting of the intestine that can occur in childhood. It causes a blockage that may cut off blood flow. Part of the intestine may be damaged as a result.

    Causes

    A birth defect called intestinal malrotation can make an infant more likely to develop a volvulus. However, a volvulus can occur without this condition present.

    Volvulus due to malrotation occurs most often in the first year of life.

    Symptoms

    Common symptoms of volvulus are:

    • Bloody or dark red stools
    • Constipation or difficulty releasing stools
    • Distended abdomen
    • Pain or tenderness in the abdomen
    • Nausea or vomiting
    • Shock
    • Vomiting green material

    Symptoms are very often severe and require emergency care. Early treatment can be critical for survival.

    Exams and Tests

    Your health care provider may order the following tests to diagnose the condition:

    Treatment

    In some cases, colonoscopy can be used to correct the problem. This involves use of a flexible tube with a light on the end that is passed into the colon (large bowel) through the rectum.

    Emergency surgery is often needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply is restored.

    If a small segment of bowel is dead from a lack of blood flow (necrotic), it is removed. The ends of the bowel are then sewn together. Or, they are used to form a connection of the intestines to the outside of the body (colostomy or ileostomy). Bowel contents can be removed through this opening.

    Outlook (Prognosis)

    Most of the time, prompt diagnosis and treatment of volvulus leads to a good outcome.

    If part of the bowel is dead, the outlook is poor. The situation may be fatal, depending on how much of the bowel is dead.

    Possible Complications

    Possible complications of volvulus are:

    • Secondary peritonitis (an infection in the abdomen)
    • Short bowel syndrome (problems that happen after removal of a large part of the small bowel)

    When to Contact a Medical Professional

    This is an emergency condition. The symptoms of childhood volvulus develop quickly and the child will become very ill. Get medical attention right away if this happens.

    Open References

    References

    Maqbool A, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 352.

    Mokha J. Vomiting and nausea. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 8.

    Srinath A, Rudolph JA. Nutrition and gastroenterology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 11.

    Thomas N, Wu AW. Large intestine. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 81.

      • Volvulus

        Volvulus - illustration

        An intestinal obstruction is a partial or complete blockage that results in the failure of the intestinal contents to pass through the bowel. A volvulus is a twisting of the bowel on itself. It is one cause of intestinal obstruction.

        Volvulus

        illustration

      • Volvulus - X-ray

        Volvulus - X-ray - illustration

        A GI series in a patient with a twisted bowel (volvulus).

        Volvulus - X-ray

        illustration

        • Volvulus

          Volvulus - illustration

          An intestinal obstruction is a partial or complete blockage that results in the failure of the intestinal contents to pass through the bowel. A volvulus is a twisting of the bowel on itself. It is one cause of intestinal obstruction.

          Volvulus

          illustration

        • Volvulus - X-ray

          Volvulus - X-ray - illustration

          A GI series in a patient with a twisted bowel (volvulus).

          Volvulus - X-ray

          illustration

        Review Date: 8/12/2024

        Reviewed By: Jenifer K. Lehrer, MD, Gastroenterologist, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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