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TÜRKÇE
Poster - 319
Should we choose prophylactic surgery in children with megadolichosigma? Experience of two colorectal surgery departments
Olga Shcherbakovа 1, Linara Khabibullina 2
1 Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical and Biological Agency, Moscow, Russia
2 Russian Children’s Clinical Hospital, Moscow, Russia
Sigmoid volvulus is a rare condition in children. However, patients with megadolichosigma frequently seek medical attention. Identifying the group at risk for sigmoid volvulus is an important task to minimize the risk of severe, life-threatening complications.
Objective: To analyze the experience of two colorectal surgery departments in treating children with sigmoid volvulus.
Results: From 2012 to 2025, 27 children with a diagnosis of megacolon were treated in two departments. Of these, 8 children (30%) had one or more episodes of sigmoid volvulus (5 girls, 3 boys). The mean age at hospitalization was 14 ± 2.6 years. The age of symptom onset ranged from 1 to 12 years. The most common complaints were abdominal distension (88%), constipation (87%), and abdominal pain (25%). All patients had radiological evidence of megadolichosigma (100%). All patients had a positive calretinin reaction on histological examination, which excluded Hirschsprung's disease. All patients underwent contrast enema, which revealed typical signs of sigmoid volvulus ("coffee bean" and "bird's beak" signs). Emergency surgery due to signs of distal intestinal obstruction was performed in 3 cases (37%). The operations included manual detorsion of the sigmoid colon (1 patient), sigmoid resection with stoma (1 patient), and ileostomy (1 patient). Sigmoid resection without stoma and without postoperative surgical complications was performed in 7 patients (87%). One patient underwent endoscopic detorsion and decompression of the colon with a silicone tube prior to surgery. Histological examination of the resected segment showed no aganglionosis or hypoganglionosis in 88% of cases; in 1 case (12%), hypoganglionosis was found in the biopsy.
Conclusion: Despite the rarity of this condition in children, pediatric surgeons need to increase their awareness to recognize patients at risk for sigmoid volvulus. This will help in making the right decision regarding the management strategy for such patients.