A volvulus is a twisting of the intestine that can occur in childhood. It causes a blockage, and may cut off blood flow and damage part of the intestine.

A birth defect called intestinal malrotation can make infants more likely to develop a volvulus. However, a volvulus can occur without malrotation.

Volvulus due to malrotation often occurs early in life, usually in the first year.

• 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 usually severe enough that infants are taken early to the emergency room, which can be critical for survival.

• Barium enema
• Blood tests to check electrolytes
• CT scan
• Stool guaiac (shows blood in the stool)
• Upper GI

Emergency surgery is needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply 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 sewn back together. Or, they are used to form a connection of the intestines to the outside, through which bowel contents can be removed (colostomy or ileostomy).

Diagnosing and treating volvulus quickly generally leads to a good outcome.

If the bowel is dead (necrotic), the outlook is poor. The situation may be life-threatening, depending on how much of the bowel is dead.

• Secondary peritonitis
• Short bowel syndrome (after removal of a large part of the small bowel)

This is an emergency condition. The symptoms of childhood volvulus develop quickly and the child becomes severely ill. Get medical attention immediately.

Peterson MA. Large Intestine. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006:chap 94.