eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Intestinal Volvulus: Follow-up

Author: Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Coauthor(s): Melissa Miller, MD, Department of Surgery, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Sep 11, 2008

Follow-up

Further Inpatient Care

  • Postoperatively, transfer the patient to an intensive care unit (ICU) and observe for signs of deterioration or recurring volvulus.
  • The patient should remain in the ICU at least until the second-look laparotomy and longer if indicated.
  • Patients continue to need aggressive fluid and electrolyte support.
  • Consider total parenteral nutrition early because edematous bowel may recuperate slowly.
  • Use antibiotics in the presence of necrotic bowel.

Transfer

  • The child with malrotation should have access to a hospital system with critical care facilities appropriate for the child's age and an experienced staff, including a pediatrician, pediatric surgeon, and radiologist. If these resources are not available, transfer the patient to a facility that can provide them.

Complications

  • The most common postoperative complications are adhesive obstruction, short-bowel syndrome, and recurrent volvulus.
  • Patients who have large portions of necrotic intestine that require resection have chronic difficulties with short-bowel syndrome.
  • Make resources available early to prevent any difficulties with long-term care.
  • Educate the parents of these patients, as well as the patients themselves, if appropriate, to prevent difficulties resulting from complications.

Prognosis

  • In the absence of serious associated abnormalities or major bowel resection, these children can be expected to do well.
  • Adhesive obstruction and recurrent volvulus are the most common complications, and, with education, they can be recognized and easily treated. The occurrence of each is recorded at less than 10%; however, patients who develop short-bowel syndrome face nutritional challenges and, possibly, difficulties with learning capacity and psychomotor development. These children also have higher mortality rates.
  • Patients with other congenital defects have a poorer prognosis, depending on the severity of the abnormality.
  • Younger children are at higher risk and require more aggressive support and treatment. In general, rapid diagnosis and facilitation of correction improve overall prognosis in all age groups.

Patient Education

  • Focus patient education on recurrence of symptoms after surgery or before surgery, if delayed.
  • Patients and their family members should understand and be sensitive to any obstructive symptoms, especially signs and symptoms of volvulus.
  • Any intolerance of food or continued abdominal symptoms may warrant reexploration of the abdomen.
  • Also instruct patients to inform any physician they visit of this medical history, especially if the appendix is left in situ.

Miscellaneous

Medicolegal Pitfalls

  • The most significant problem is failure to recognize midgut volvulus in the differential diagnosis of a child with a history of bilious vomiting. One must remember that the signs and symptoms of an acute abdomen may be absent if intestinal ischemia and necrosis have not yet developed.
 


More on Intestinal Volvulus

Overview: Intestinal Volvulus
Differential Diagnoses & Workup: Intestinal Volvulus
Treatment & Medication: Intestinal Volvulus
Follow-up: Intestinal Volvulus
Multimedia: Intestinal Volvulus
References
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References

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Further Reading

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Keywords

intestinal volvulus, intestinal malrotation, volvulus, midgut volvulus, cecal malposition, cecal volvulus, gastrointestinal malrotation, GI malrotation, mesenteric twisting, nonfixation of the intestines, congenital duodenal obstruction, nonrotation, Ladd's procedure, Ladd procedure, Ladd's bands, Ladd bands, gastroschisis, diaphragmatic hernias, hyperrotation, ischemia, mucosal necrosis, intramural air formation, gram-negative sepsis, perforation, peritonitis, malnutrition, short-bowel syndrome, renal failure, hepatic failure, adhesive obstruction, intussusception, bilious vomiting, anorexia, intermittent apnea, failure to thrive, cyclic vomiting, dehydration, lethargy, respiratory distress, Down syndrome, trisomy 21, congenital heart disease, imperforate anus, omphalocele, duodenal atresia, duodenal stenosis, diaphragmatic hernia, Meckel diverticulum, VACTERL, esophageal atresia, pyloric stenosis, erythroblastosis, cystic fibrosis, meconium ileus, Hirschsprung disease, duodenal web, biliary atresia

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Contributor Information and Disclosures

Author

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Melissa Miller, MD, Department of Surgery, Medical University of South Carolina
Melissa Miller, MD is a member of the following medical societies: American Medical Association and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey J DuBois, MD, Consulting Staff, Division of Pediatric Surgery, Kaiser Permanente, North Sacramento Medical Center
Jeffrey J DuBois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, California Medical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

B U K Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B U K Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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