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E1949. Imaging Spectrum of Abdominal Visceral Torsion in Pediatric Population
Authors
  1. Ankita Chauhan; The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
  2. Anand Raju; The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
  3. Vijay Pande; The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
Background
Determining the cause of abdominal pain in the pediatric age group is challenging, particularly in patients less than two years old (nonspecific symptoms: inconsolable crying, fussiness, and lethargy). Associated symptoms often direct differential considerations and subsequent imaging. A bilious emesis point to an upper gastrointestinal (GI) obstruction and currant jelly stool suggests a lower GI pathology (intussusception). Toddlers and preschool children can often describe the type and location of abdominal pain. Surgical conditions in these children include intestinal malrotation/volvulus, intussusception, and acute appendicitis. Differentials of abdominal pain in patients older than 12 years are similar to young adults. This exhibit will focus on abdominal visceral torsion, a significant cause of acute or recurring abdominal pain, and a surgical emergency.

Educational Goals / Teaching Points
As volvulus's signs and symptoms are often nonspecific, a delay in diagnosing can have dire consequences. Prompt diagnosis is essential. We will exhibit the entire imaging spectrum of abdominal visceral torsion, including midgut volvulus, gastric volvulus, small bowel internal hernia with volvulus, small bowel intussusception with volvulus, bezoar causing volvulus, cecal volvulus, colonic volvulus, sigmoid volvulus, and splenic torsion. We will demonstrate their classic imaging appearance and emphasize on strategies for achieving an accurate diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The hollow and solid viscus is secured in place by various suspensory ligaments. Incomplete development and laxity of these ligaments predispose visceral torsion. Prompt diagnosis of torsion (prolonged visceral ischemia) helps to avoid life-threatening situations. Radiologists are entrusted to make this diagnosis. Ultrasound is often the initial modality detecting abnormalities of the GI tract in children, often as part of a targeted exam at the site of symptoms. Radiologists interpreting sonographic examinations in children should be familiar with the normal and abnormal GI tract's sonographic appearance to provide the best care for pediatric patients with abdominal diseases. It is the radiologist's responsibility to recognize and diagnose volvulus promptly. We will review the imaging spectrum of abdominal visceral torsions with surgical findings.

Conclusion
Any portion of the gastrointestinal tract, from the stomach to the colon, can become torsed. The clinical presentation of intraabdominal visceral torsion is nonspecific, and imaging is instrumental in guiding diagnosis and treatment. Recognizing the predisposing factors and imaging findings of intraabdominal torsions is essential to ensure timely intervention in these potentially life-threatening entities. We will summarize the typical imaging features of different types of abdominal visceral torsions in children.