eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Volvulus: Follow-up

Author: Jonathan E Markowitz, MD, Associate Professor of Clinical Pediatrics, University of South Carolina School of Medicine; Attending Pediatric Gastroenterologist, Associate Director of Pediatric Residency Program, Greenville Hospital System
Coauthor(s): Liz D Dancel, MD, Intern, Department of Pediatrics, Greenville Hospital System University Medical Center; Prem C Shukla, MD, Associate Chairman, Associate Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: May 13, 2008

Follow-up

Further Inpatient Care

  • All patients with acute presentations require admission to the hospital.
  • Individuals with GI hemorrhage or shock require volume resuscitation, urgent surgical presentation, and intensive care in the postoperative period.

Complications

  • Midgut volvulus has a mortality rate of 3-15%.
    • Delay in operation leads to higher mortality rates.
    • Usually, the lower acceptable limit of bowel length is considered 25 cm with an intact ileocecal valve and 42 cm without an ileocecal valve.
    • In patients with bowel necrosis, the length of bowel resected also determines survival. Messineo et al demonstrated this in a 1992 study of 182 patients undergoing laparotomy for malrotation, in which they found a 0.999 estimated probability of survival in patients with 10% bowel necrosis, a 0.920 estimated probability in patients with 50% necrosis, and a 0.351 estimated probability in patients with 75% necrosis.4
  • Short gut syndrome, with its inherent complications of long-term parenteral nutrition (eg, line sepsis, growth retardation, hepatobiliary dysfunction), is associated with high morbidity and mortality.
  • Prognosis of midgut volvulus depends on prompt recognition before bowel necrosis occurs. All these complications can be prevented by operation on incidentally discovered malrotation in asymptomatic patients.

Prognosis

Miscellaneous

Medicolegal Pitfalls

  • Consider unexplained bilious vomiting in an otherwise healthy infant a surgical emergency; likewise, assume malrotation with midgut volvulus until proven otherwise.
  • Some would consider the use of prokinetics in infants inadvisable until imaging has ruled out intestinal malrotation.
  • Devastating medical and legal complications in these patients can be prevented if this diagnosis is considered in any patient with abdominal pain and signs of intestinal obstruction.
 


More on Volvulus

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

For more information, see the eMedicine article Sigmoid Volvulus.

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Keywords

midgut volvulus, intestinal malrotation, superior mesenteric artery, SMA, midgut, rotational abnormality, extracoelomic elongation, duodenal loop, cecocolic loop, Ladd bands, sigmoid volvulus, duodenal atresia, Meckel diverticulum, intussusception, small bowel atresia, prune belly syndrome, gastric volvulus, persistent cloaca, Hirschsprung disease, extrahepatic biliary anomalies, Chagas disease, feeding intolerance, failure to thrive, constipation, bloody diarrhea, hematemesis, irritable bowel syndrome, peptic ulcer disease, kidney stones, peritonitis, hematochezia, ischemia, gangrene, intestinal ischemia, necrosis, abdominal distension, hypovolemia, septic shock

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Contributor Information and Disclosures

Author

Jonathan E Markowitz, MD, Associate Professor of Clinical Pediatrics, University of South Carolina School of Medicine; Attending Pediatric Gastroenterologist, Associate Director of Pediatric Residency Program, Greenville Hospital System
Jonathan E Markowitz, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, Crohns and Colitis Foundation of America, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Coauthor(s)

Liz D Dancel, MD, Intern, Department of Pediatrics, Greenville Hospital System University Medical Center
Disclosure: Nothing to disclose.

Prem C Shukla, MD, Associate Chairman, Associate Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences
Prem C Shukla, MD is a member of the following medical societies: American Academy of Emergency Medicine
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.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

David A Piccoli, MD, Chief, Division of Gastroenterology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine
David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, 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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