Volvulus in children symptoms
Volvulus in children is a physiological disorder affecting the rotation of the small and large intestines the symptoms often already evident in newborns and infants with acute colic, the baby, the baby or child of preschool age most frequently suffer from disorders of passage through the gastrointestinal tract, often occurring intussusception.
Adults and school-age children make up 25% of patient visits to the doctor with this problem.
The rule for this congenital malformation of the gastrointestinal tract is that the earlier shows volvulus in children symptoms and is clinically manifested, the more favorable the results of intraoperative and postoperative long-term prognosis. A significant development in prenatal diagnosis now facilitates the early detection of the disease.
Normally laid intestine is the result of the rotation of the tip formation (part of the intestine from the duodenum to the middle of the transverse column) in the early stages of embryonic development. Its axis consists of artery mesenterica superior and ductus omphaloentericus.
The rotation begins in the fourth week of pregnancy. Protonema revolves around artery counterclockwise from the initial position to the sagittal position, known from General anatomy. Rotation, extension and fixation of the intestine occurs within the first three months of life. Fixation of the intestine to the rear abdominal wall occurs during the rotation continues and after its completion. With incomplete fixation of the bowel is fixed to the upper mesenteric vessels and tends to volvulus.
After the start of rotation of the intestine and intestinal lengthening the length of an average intestine moves to the umbilical cord. After 10 weeks of fetal life intestinal loop returns to the abdominal cavity, and continues the rotation and fixation of the intestine. Fixing duodenalnogo bending is final in the early phase of the turn.
Fixation of the columns occurs later, shortly before the birth. Therefore, in premature infants the frequent appearance of excessive mobility of the cecum or high state.
Knowledge of the embryological laws is an essential factor in order to correctly identify volvulus in a child and its type. The selection of an inappropriate surgical technique could mean not only the reoperation, but the patient's death.
In accordance with the phase in which the rotation of the intestine stops, there are several subgroups of volvulus.
- Compression of the duodenum.
- Congenital volvulus .
- The Ladd's Syndrome.
- Internal hernia.
- Insulated high as the cecum.
The most severe subgroup, in terms of early diagnosis, current surgery and the subsequent quality of life is congenital volvulus.
This disorder in the population occurs in 0.5-2%. It is approximately 1 patient in 500 births. Up to 75% of cases of this pathological condition manifests itself in the neonatal period, i.e. within 6 weeks of age, even in 90% of patients within the first year of life.
Clinical symptoms (per 100 people):
Clinical symptoms Number of patients
Abdominal pain 79
Vomiting bile/blood 72
Vomiting without any admixture of bile 1
Diarrhea without any admixture of 12
Diarrhea with mucus/blood 7
Stop weight 12
In the first place, dominates this symptom as abdominal pain, accompanied by anxiety, weeping, followed by vomiting, often mixed with bile. The pain is in the nature of colic comes and attacks. In older people, school-age children abdominal pain present in the long term, are often ambiguous, is more oppressive in nature. Can lead to cardiac in weight, weight loss and increased incidence of with normal ultrasound results. Vomiting in older patients, mainly girls, can be confused with symptoms of anorexia. Bloating is typical for newborns and infants. These symptoms occur soon after the onset of pain in the abdomen.
A special group of children with low body weight at birth in patients with an average body weight at birth 660g, bloating is often associated with a rapidly progressive sepsis.
Sudden pain in the abdomen, the nature of colic, repeated vomiting with impurities bile (later blood), dehydration from rapid loss of volume, and metabolic acidosis characteristic of congenital inversion. In a young patient relatively quickly develops shock due to the combination of pain anddehydrations.
An example of the clinical picture
An example is the case of 2-year-old patient. Girl with 12-hour history of colicky abdominal pain and vomiting during the admission to the hospital was in a weak state, on his head was attended by numerous bruises, there was subfebrile, tachycardia, shallow breathing. On palpation the abdomen was discovered palpable mass.
In view of the suspicion on cherepno-a brain trauma was performed CT of the brain with a negative result, which the patient has been shown examination of the abdominal cavity.
Intraoperatively was discovered the extensive volvulus average bowel need resection of part of the small loops due to necrosis of the wall.
The mother of a child when adopting a girl in the hospital indicated that the girl was up all night in pain, which was so expressive that the child is "banging his head on the bed," but the doctor went in the morning.
Further clinical signs can include diarrhea, usually without impurities. Constipation can occur only occasionally. Anemia is a very rare condition and is more characteristic for older patients. Duration of clinical symptoms in patients varies from 6 hours to 16 years!
Diagnosis of diseases
In the first place is the abdominal cavity, supplemented by ultrasound. In the case of unclear findings is complemented by the passage of water digestive tract contrast agent and irrigography study (barium enema). This method is most often used when a sudden abdominal pain with acute and subacute course. Chronic pain in the abdomen first and foremost is abdominal ultrasound, with subsequent CT or MRI.
If you experience acute pain in the abdomen always, you should consult a pediatric surgeon, if necessary, start treatment immediately. Prolonged stomach pain when the standard tests do not determine their etiology, it is advisable to complement a diagnostic laparoscopic examination of abdominal cavity organs.