A birth defect called intestinal malrotation can make an infant more likely to develop a volvulus. However, a volvulus can occur without this condition present.

Volvulus due to malrotation occurs most often in the first year of life.

Common symptoms of volvulus are:

• Bloody or dark red stools
• Constipation or difficulty releasing stools
• Distended abdomen
• Pain or tenderness in the abdomen
• Nausea or vomiting
• Shock
• Vomiting green material

Symptoms are very often severe and require emergency care. Early treatment can be critical for survival.

Your health care provider may order the following tests to diagnose the condition:

• Barium enema
• Blood tests to check electrolytes, infection, blood count, and others
• CT scan
• Stool test for occult blood (shows small amounts of blood in the stool)
• Upper GI series

In some cases, colonoscopy can be used to correct the problem. This involves use of a flexible tube with a light on the end that is passed into the colon (large bowel) through the rectum.

Emergency surgery is often needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply is restored.

If a small segment of bowel is dead from a lack of blood flow (necrotic), it is removed. The ends of the bowel are then sewn together. Or, they are used to form a connection of the intestines to the outside of the body (colostomy or ileostomy). Bowel contents can be removed through this opening.

Most of the time, prompt diagnosis and treatment of volvulus leads to a good outcome.

If part of the bowel is dead, the outlook is poor. The situation may be fatal, depending on how much of the bowel is dead.

Possible complications of volvulus are:

• Secondary peritonitis (an infection in the abdomen)
• Short bowel syndrome (problems that happen after removal of a large part of the small bowel)

This is an emergency condition. The symptoms of childhood volvulus develop quickly and the child will become very ill. Get medical attention right away if this happens.

Childhood volvulus; Abdominal pain - volvulus; Sigmoid volvulus; Cecal volvulus; Acute colonic pseudo-obstruction (ACPO)

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Mokha J. Vomiting and nausea. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 8.

Srinath A, Rudolph JA. Nutrition and gastroenterology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 11.

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Updated by: Jenifer K. Lehrer, MD, Gastroenterologist, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.