(303) Analysis of Children Hospitalized With Sigmoid Volvulus in the United States From 2016 to 2019

Introduction: Sigmoid volvulus is rare in the pediatric population, and the constellation of vague symptoms makes it difficult to diagnose. The objective of this study was to describe the demographics, complications, and outcomes in children with sigmoid volvulus.

Methods: We retrospectively analyzed the Kids’ Inpatient database for the years 2016 and 2019. Hospitalized children from 1 month to 20 years with an ICD 10 diagnosis code of volvulus and ICD 10 procedure codes of intervention on the sigmoid colon were combined and selected as sigmoid volvulus. Univariate was performed to assess the risk of a complication on mortality. Results are presented as frequency and odds ratio for categorical data and median with interquartile ranges for continuous variables.

Results: In the years 2016 and 2019, there were a total of 4,433,750 discharges, out of which 223 children were diagnosed with sigmoid volvulus, resulting in a prevalence of 5 per 100,000 discharges. Among the children with sigmoid volvulus, the median age was 16 years (IQR: 11-18) and the majority were adolescents (74.3% vs. 54.5%), White (57.3% vs. 48.6%), female (54.3% vs. 43.8%), and belonged to a high-income group (24.0% vs. 18.4%) compared to the rest of the discharges. Among the children with sigmoid volvulus, 28.7% had a technology-dependent complex chronic condition (CCC), 9.9% had a congenital or genetic CCC, and 7.2% had a neuromuscular CCC. Constipation was documented in 33.8%. The mortality rate associated with sigmoid volvulus was 3.1%. Mortality was significantly higher with bacterial sepsis (57.4%, OR 11.7, 95% CI: 2.4-55.9), congenital or genetic CCC (42.9%, OR=7.7, 95% CI: 1.6-37.3), and neuromuscular CCC in (42.9%, OR=10.8, 95% CI: 2.2-53.4). The median hospital stay of 7 days (IQR: 5-12) and the total hospital charges were $80,368 (IQR: $51,726-$147,092).

Conclusions: Sigmoid volvulus is a rare condition in children, but it can lead to a significant risk of mortality. Constipation is commonly observed in children with sigmoid volvulus. Children with CCC are at a higher risk for the development of sigmoid volvulus. For a child with a complex chronic condition presenting with constipation and abdominal symptoms, healthcare providers should maintain a high level of suspicion for sigmoid volvulus.