A systematic review of the management and outcomes of cecal and appendiceal volvulus in children

Abstract

Aim: Appendiceal volvulus (AV) and cecal volvulus (CV) are rare conditions and there is no consensus regarding the best surgical approach. This study reviewed CV and AV management and outcomes in children.

Methods: PubMed was reviewed from 1990 to 2018 for AV and CV in children and studies published in English were selected by two independent reviewers. This identified 24 papers that provided case reports on 29 children (72% male) with a median age of 10 years.

Results: Abdominal distension and abdominal pain were the most common symptoms and seven children had Cornelia de Lange syndrome. The initial treatment was surgical in 27 cases and endoscopic in 2. In 23 children, variants of cecopexy were performed. There was no mortality. Complications occurred in seven cases: five with sepsis and two with enterocutaneous fistulas. There were three CV recurrences and these were all in cases where cecopexy was not performed.

Conclusion: AV and CV are rare paediatric pathologies. Since a quarter of the patients had Cornelia de Lange syndrome, it is paramount to consider CV when abdominal symptoms occur. Complications were minor with prompt management. In order to reduce recurrence, cecopexy is recommended in CV cases and appendectomy in AV cases.

Keywords: Appendiceal volvulus; Cecal volvulus; Cecopexy; Cornelia de Lange syndrome rare conditions.