Volvulus
Can present any any age
Most seen in first month
Positive FHx, M:F = 2:1
Caused by malrotation
Abnormally fixed mesentry (normal bowel)
Signs and symptoms
- Bilious vomiting (cf pyloric stenosis)
- Dehydration and shock
- Grunting respirations (beware airway compromise or peritonism)
- Jaundice in about 1/3
- Bloody stools (late sign)
Investigations
- Dilated stomach and proximal duodenum, no gas distally
- Air contrast may reveal the double bubble sign
- Contrast studies - narrowing at site of obstruction
- Spiraling of small bowel about the superior mesenteric artery (SMA)
Management
- ABC’s
- Fluid resuscitation
- NPO/ NG tube
- Antibiotic coverage (please check local policy
