Sigmoid Volvulus in Children: A Structured Diagnostic and Therapeutic Approach.

Purpose: Sigmoid volvulus rarely causes bowel obstruction in children. Early diagnosis and treatment are critical for preventing complications such as bowel ischemia and peritonitis. This study aimed to develop a structured diagnostic and treatment algorithm for sigmoid volvulus in pediatric patients. Methods: Two clinical cases of pediatric sigmoid volvulus were reviewed, focusing on the clinical presentation, diagnosis, and surgical treatment. These findings were compared with those in the literature to establish evidence-based recommendations. Results: Sigmoid volvulus should be considered in children who present with abdominal pain and signs of intestinal obstruction. The initial diagnosis can be made using abdominal radiography with computed tomography scans, if necessary. Colonoscopy with endoscopic detorsion of the volvulus is recommended in the absence of peritonitis. Owing to the high risk of recurrence, early resection of the sigmoid colon is recommended. Rectal biopsy is a key component of the diagnostic algorithm as it helps to confirm or exclude Hirschsprung's disease. Acute surgical intervention is indicated in children with clinical signs of peritonitis and/or pneumoperitoneum. Resection of the affected sigmoid bowel with or without primary anastomosis is recommended. Indocyanine green fluorescence imaging is a promising method for objectively evaluating bowel viability when viability is uncertain. Conclusion: The proposed diagnostic and therapeutic algorithm offers a clear approach for managing sigmoid volvuli in pediatric patients.