Symptoms
Symptoms of an acute volvulus are cramp-like abdominal pain, a bloated abdomen, vomiting (greenish), diarrhea (sometimes bloody), peritonitis and shock. A chronically recurrent volvulus is manifested by a reduced absorption of food components (malabsorption), unspecific abdominal pain and constipation in the child.
Diagnosis
Diagnosis is mainly based on imaging procedures such as an X-ray of the abdomen (with contrast medium if necessary) or ultrasound. This reveals a massive over-inflation of the preceding bowel segments. The volvulus of the sigmoid is characterized by the so-called coffee bean sign, where inflated ascending intestinal loops lie close to a descending intestinal loop and both together look like a coffee bean.
If the intestine is already ruptured (perforated), there is a lot of free air around x-ray/ultrasound. In the case of volvulus in newborns or chronic courses of disease, the diagnosis is much more difficult, since in these cases the X-ray image is usually inconspicuous. An X-ray abdomen overview usually shows specific indications depending on the location of the volvulus.
In a CT abdomen overview of the abdomen, on the other hand, the unspecific “whirlpool” sign, or “whirl-sign” for short, appears. This sign occurs when a structure is twisted, as in the intestinal volvulus. In this case, the intestine rotates around its tissue suspension together with the vessels inside.
This creates the “vertebra” on the CT image. The vertebra is also visible in the case of ovarian torsion. In the case of a volvulus, the stomach and intestinal sections appear inflated and dilated before the twisting.
The mobility of the intestinal loops is restricted. The “whirlpool” sign can also be seen in abdominal sonography in the case of an intestinal volvulus. The upper supplying vein usually wraps around the upper artery.The delicate blood flow situation can be easily visualized in sonography with the aid of a Doppler examination, in which the direction of blood flow can be traced.