Abstract：
BACKGROUND: Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE: This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
CONCLUSIONS: Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments.
CONCLUSIONS: An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
OBJECTIVE: This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
CONCLUSIONS: Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments.
CONCLUSIONS: An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
摘要：
背景：小儿消化扭转是一种严重的疾病，其发病率和死亡率很高。
目的：这篇综述强调了小儿消化道扭转的珍珠和陷阱，包括演讲，诊断,并根据当前证据对急诊科（ED）进行管理。
结论：小儿消化道扭转是一种最常与旋转不良相关的致命疾病。它发生在胃或小肠自身扭曲时，导致缺血和潜在的绞窄坏死和穿孔。根据受影响的胃肠道（GI）段，扭曲程度，和扭转的敏锐度。胃扭转最常表现为干裂伴或不伴非胆汁性呕吐和上胃部不适伴疼痛。而中肠扭转通常在婴儿中表现为胆汁性呕吐。胃肠道坏死和穿孔患者可出现血流动力学受损和腹膜炎。如果怀疑,紧急咨询儿科外科专家是必要的，如果这个不可用,建议转移到儿科外科医生的中心。影像学包括平片，超声，或上GI系列，虽然治疗包括复苏，抗生素的管理，并对受累节段进行紧急手术减压和切除。
结论：了解小儿消化道扭转及其许多潜在的模拟物可以帮助急诊临床医生诊断和管理这种致命疾病。
目的：这篇综述强调了小儿消化道扭转的珍珠和陷阱，包括演讲，诊断,并根据当前证据对急诊科（ED）进行管理。
结论：小儿消化道扭转是一种最常与旋转不良相关的致命疾病。它发生在胃或小肠自身扭曲时，导致缺血和潜在的绞窄坏死和穿孔。根据受影响的胃肠道（GI）段，扭曲程度，和扭转的敏锐度。胃扭转最常表现为干裂伴或不伴非胆汁性呕吐和上胃部不适伴疼痛。而中肠扭转通常在婴儿中表现为胆汁性呕吐。胃肠道坏死和穿孔患者可出现血流动力学受损和腹膜炎。如果怀疑,紧急咨询儿科外科专家是必要的，如果这个不可用,建议转移到儿科外科医生的中心。影像学包括平片，超声，或上GI系列，虽然治疗包括复苏，抗生素的管理，并对受累节段进行紧急手术减压和切除。
结论：了解小儿消化道扭转及其许多潜在的模拟物可以帮助急诊临床医生诊断和管理这种致命疾病。
