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*Sigmoid volvulus has been reported in children and adolescents and is usually associated with abnormal colonic peristalsis.
*Sigmoid volvulus has been reported in children and adolescents and is usually associated with abnormal colonic peristalsis.
*Gastric volvulus is rare and the incidence peaks after the fifth decade.  
*Gastric volvulus is rare and the incidence peaks after the fifth decade.  
*The incidence of neonatal and infantile volvulus is unknown since non-rotation or malrotation of the gut may remain asymptomatic throughout life.<ref name="Burns2006">{{cite journal|last1=Burns|first1=Cartland|title=Principles and Practices of Pediatric Surgery|journal=Annals of Surgery|volume=243|issue=4|year=2006|pages=567|issn=0003-4932|doi=10.1097/01.sla.0000208423.52007.38}}</ref>
**In the United States, non-rotation is an incidental finding in 2 out of 1000 upper gastrointestinal contrast studies.
**In the United States, symptomatic malrotation in neonates occurs in 1 in 6000 live births.


===Race===
===Race===
Line 41: Line 44:
*In the United States, volvulus only accounts for 10% of cases with intestinal obstruction.
*In the United States, volvulus only accounts for 10% of cases with intestinal obstruction.


==Neonatal and Infantile volvulus==


Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. Because rotational anomalies may remain asymptomatic throughout a person’s life span, the true incidence is not known. Nonrotation, a type of malrotation is an incidental finding on approximately 2 out of 1000 upper gastrointestinal contrast studies [1]. Symptomatic malrotation in neonates occurs with a frequency of about 1 in 6000 live births.


Traditionally, intestinal malrotation has been considered primarily a disease of infancy with infrequent occurrence beyond the first year of life [2,3]. However, analysis of 2744 cases of intestinal rotation in children up to 17 years of age obtained from a national hospital discharge database found the following [2]:
●Presentation by one month of age: 30 percent
●Presentation before one year of age: 58 percent
●Presentation before five years of age: 75 percent
Similarly, in a series of 170 patients of all ages with symptomatic intestinal malrotation managed at a single institution, age distribution at time of presentation was as follows [3]:
●Infants under one year of age: 31 percent
●Children 1 to 18 years of age: 21 percent
●Adults over 18 years of age: 48 percent
Thus, the prevalence of malrotation in children over one year of age and adults appears to be higher than previously thought.
Associated congenital defects — Up to 62 percent of children who have intestinal malrotation have an associated anomaly (table 1) [4-7].
Based upon a systematic review of small, single-institution studies, the following conditions have demonstrated a strong association with intestinal malrotation [8]:
●Congenital diaphragmatic hernia – Up to 100 percent
●Congenital heart disease, especially heterotaxy syndrome – 40 to 90 percent (see 'Screening' below)
●Omphalocele – 31 to 45 percent
Intestinal malrotation is also associated with:
●Gastroschisis (see "Gastroschisis", section on 'Associated anomalies and findings')
●Prune belly syndrome (see "Prune-belly syndrome", section on 'Abdominal wall and gastrointestinal tract')
●Certain types of intestinal atresias [9] (see "Intestinal atresia")
●Esophageal atresia (solitary and with tracheoesophageal fistula) [10]
●Biliary atresia in patients with laterality malformations (see "Biliary atresia", section on 'Types of biliary atresia')
●Meckel diverticulum [11]
●Complex anorectal malformations or anorectal malformations with 2 or more anomalies of the VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb) complex [12,13]
●Cornelia de Lange syndrome [14]


==References==
==References==

Revision as of 18:57, 27 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: ; Hadeel Maksoud M.D.[2]


Overview

Acute mechanical small bowel obstruction is a common surgical emergency where volvulus is the cause in 10% of cases. It is estimated that over 300,000 laparotomies are performed per year in the United States for adhesion-related obstructions such as volvulus .

Epidemiology and Demographics

Incidence

  • The incidence of volvulus is approximately 2 per 100,000 individuals worldwide.[1][2][3][4]
  • Sigmoid volvulus has the highest incidence accounting for 75 - 80% of volvulus cases.
  • Cecal volvulus has the second highest incidence accounting for 20 - 25% of volvulus cases.
  • The incidence of cecal volvulus increases by 5.53 percent per year, whereas the incidence of sigmoid volvulus remains stable.
  • In other studies, the incidence of cecal volvulus ranges from 2.8 to 7.1 per million people per year.
  • The incidence of gastric volvulus is rare.[5]

Prevalence

  • In 2002 - 2010, the prevalence of colonic volvulus is estimated to be 63,749 cases in the United States annually.[4]

Case-fatality rate/Mortality rate

  • The mortality rate of volvulus is approximately 7%.[3]

Age

  • The incidence of volvulus increases with age; the median age at diagnosis is 70 years.[4][6][5]
  • Sigmoid volvulus has been reported in children and adolescents and is usually associated with abnormal colonic peristalsis.
  • Gastric volvulus is rare and the incidence peaks after the fifth decade.
  • The incidence of neonatal and infantile volvulus is unknown since non-rotation or malrotation of the gut may remain asymptomatic throughout life.[7]
    • In the United States, non-rotation is an incidental finding in 2 out of 1000 upper gastrointestinal contrast studies.
    • In the United States, symptomatic malrotation in neonates occurs in 1 in 6000 live births.

Race

  • Volvulus usually affects individuals of the Black race.[8][9]
    • Black individuals are at increased risk for volvulus because they tend to have a longer mesentery and sigmoid colon.

Gender

  • Most studies have found that volvulus affects men and women equally.[10][11][12]
  • Although some studies have found a predominance in men, cecal volvulus has been found to be more prevalent in younger females.

Region

  • The majority of volvulus cases are reported in Russia, India, Iran, Norway and Africa.[3]
  • In the United States, volvulus only accounts for 10% of cases with intestinal obstruction.



References

  1. ↑ Katoh T, Shigemori T, Fukaya R, Suzuki H (2009). "Cecal volvulus: report of a case and review of Japanese literature". World J. Gastroenterol. 15 (20): 2547–9. PMC 2686916. PMID 19469008.
  2. ↑ Consorti ET, Liu TH (2005). "Diagnosis and treatment of caecal volvulus". Postgrad Med J. 81 (962): 772–6. doi:10.1136/pgmj.2005.035311. PMC 1743408. PMID 16344301.
  3. ↑ 3.0 3.1 3.2 Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM (1985). "Volvulus of the colon. Incidence and mortality". Ann. Surg. 202 (1): 83–92. PMC 1250842. PMID 4015215.
  4. ↑ 4.0 4.1 4.2 Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2014). "Colonic volvulus in the United States: trends, outcomes, and predictors of mortality". Ann. Surg. 259 (2): 293–301. doi:10.1097/SLA.0b013e31828c88ac. PMID 23511842.
  5. ↑ 5.0 5.1 Wu MH, Chang YC, Wu CH, Kang SC, Kuan JT (2010). "Acute gastric volvulus: a rare but real surgical emergency". Am J Emerg Med. 28 (1): 118.e5–7. doi:10.1016/j.ajem.2009.04.031. PMID 20006232.
  6. ↑ Krupsky S, Halevy A, Orda R (1987). "Sigmoid volvulus in adolescence". J. Clin. Gastroenterol. 9 (4): 467–9. PMID 3655280.
  7. ↑ Burns, Cartland (2006). "Principles and Practices of Pediatric Surgery". Annals of Surgery. 243 (4): 567. doi:10.1097/01.sla.0000208423.52007.38. ISSN 0003-4932.
  8. ↑ Madiba TE, Aldous C, Haffajee MR (2015). "The morphology of the foetal sigmoid colon in the African population: a possible predisposition to sigmoid volvulus". Colorectal Dis. 17 (12): 1114–20. doi:10.1111/codi.13042. PMID 26112767.
  9. ↑ Michael SA, Rabi S (2015). "Morphology of Sigmoid Colon in South Indian Population: A Cadaveric Study". J Clin Diagn Res. 9 (8): AC04–7. doi:10.7860/JCDR/2015/13850.6364. PMC 4576524. PMID 26435933.
  10. ↑ Påhlman L, Enblad P, Rudberg C, Krog M (1989). "Volvulus of the colon. A review of 93 cases and current aspects of treatment". Acta Chir Scand. 155 (1): 53–6. PMID 2929205.
  11. ↑ Baker DM, Wardrop PJ, Burrell H, Hardcastle JD (1994). "The management of acute sigmoid volvulus in Nottingham". J R Coll Surg Edinb. 39 (5): 304–6. PMID 7861341.
  12. ↑ Isbister WH (1996). "Large bowel volvulus". Int J Colorectal Dis. 11 (2): 96–8. PMID 8739835.

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