IMAGE

OF THE

MONTH

Sigmoid Colon Volvulus in Early Infancy: Do Not Miss It!

FIGURE 1. A, Upright abdominal radiograph demonstrating marked bilateral bowel loop dilatation (B). Increased distance between abdominal wall and bowel loops
in the right upper quadrant (arrows) suggests the presence of free abdominal fluid. B, Supine abdominal radiograph showing increased caliber of distended bowel
loop (B) in the right abdomen as compared with the other bowel loops, which raises suspicions for a closed loop obstruction or volvulus.

A 7-week-old previously healthy boy presented at our emergency department with apathy and abdominal distention. Plain abdominal films showed dilated bowel
loops suggestive of distal obstruction (Fig. 1A). Sonography showed a moderate amount of free fluid and ruled out intussusception. Repeat films were suspicious for a
closed loop obstruction (Fig. 1B). Operative treatment was chosen because diagnosis was not clear. Surgery revealed sigmoid volvulus due to a narrow mesentery
neck. The bowel was viable, and detorsion was performed. Recovery was uneventful, and postoperative rectal biopsy was normal.
Volvulus of the sigmoid colon is a rare cause of bowel obstruction occurring mostly in the adult population. It is exceedingly rare in infancy (1). Presenting symptoms
are abdominal distention, obstipation, and vomiting. Delay in interventionradiological, endoluminal, or surgical (2)may lead to bowel infarction with high
mortality (22%50% in infants) (3). A high level of suspicion will lead to timely intervention and is the only way to salvage the bowel. Treatment may consist of
detorsion alone or with sigmoidopexy, avoiding the need for resection or colostomy. The recurrence rate in this population is low (3) and sigmoidoscopy could
suffice. Further investigations aimed toward anorectal anomalies or Hirschsprung disease should be carried out after convalescence (4).
Submitted by:


Yaron Armon, MD, yBenjamin Z. Koplewitz, MD, zRam Elazary, MD, and Dan Arbell, MD

Department of Pediatric Surgery, yDepartment of Medical Imaging, and zDeparment of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem,
Israel.
Address correspondence and reprint requests to Dr Yaron Armon, Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, PO Box 12000,
IL-91120 Jerusalem, Israel (e-mail: ayaron@hadassah.org.il).

The authors report no conflicts of interest

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated
photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images.
Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as
by the Journal.

REFERENCES
1.
2.
3.
4.

Ballantyne GH, Brandner MD, Beart RW, et al. Volvulus of the colon incidence and mortality. Ann Surg 1985; 202:832.
Salas S, Angel CA, Salas N, et al. Sigmoid volvulus in children and adolescents. J Am Coll Surg 2000;190:71723.
Atamanalp SS, Yildirgan MI, Basoglu M, et al. Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004;20:49295.
Teich S, Schisgall RM, Anderson KD. Ischemic enterocolitis as a complication of Hirschsprungs disease. J Pediatr Surg 1986;21:14345.

Copyright # 2010 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition
DOI: 10.1097/MPG.0b013e3181f41859

JPGN

Volume 51, Number 6, December 2010

689

Copyright 2010 by ESPGHAN and NASPGHAN. Unauthorized reproduction of this article is prohibited.