Midgut malrotation and volvulus. Which films ar most helpful
TL;DR: The upper gastrointestinal series was useful in defining extrinsic duodenal obstruction, but was difficult to interpret if the patient was asymptomatic when studied.
Abstract: Midgut malrotation is a surgical emergency usually seen in the first weeks of life. It presents with duodenal obstruction and bile emesis; the signs may be intermittent or minimal. The advantages and limitations of plain films, barium enema studies, and gastrointestinal studies were reviewed in 77 patients with malrotation; volvulus was seen in 65. Additional experience was gained from a questionnaire among members of the Society for Pediatric Radiology. Barium enema studies were preferred by 39 respondents. The upper gastrointestinal series was useful in defining extrinsic duodenal obstruction, but was difficult to interpret if the patient was asymptomatic when studied.
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TL;DR: The authors present their US findings in 24 patients with proved complicated midgut malrotation: volvulus in 18 and occlusive Ladd's bands in 6, and Embryological signification of midGut mal rotation is discussed.
Abstract: The authors present their US findings in 24 patients with proved complicated midgut malrotation: volvulus in 18 and occlusive Ladd's bands in 6. All the 24 patients have had US examination prior to surgery. Contrast examinations were performed in only 9 patients, always after US and before surgery. The sonographic “whirlpool’ pattern of the superior mesenteric vein and mesentery around the superior mesenteric artery was detected in 15 of the 18 patients with midgut volvulus, and was best seen using Doppler color. Embryological signification of midgut malrotation is discussed.
216 citations
Cites background from "Midgut malrotation and volvulus. Wh..."
...Unfortunately, these radiological investigations are not always reliable and well tolerated, and are t ime consuming [3, 4]....
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...Radiological misinterpretation of the position of the duodenojejunal junction or cecal position may lead to errors, because there is a pattern of non-rotation of the normal presentation after a 270 ~ rotation of the primitive gut [1, 3]....
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TL;DR: In this essay, the radiologic findings of malrotation and volvulus are reviewed and illustrated with particular attention to the child with equivocal imaging findings.
Abstract: Malrotation with volvulus is one of the true surgical emergencies of childhood. Prompt radiological diagnosis is often paramount to achieving a good outcome. An understanding of the normal and anomalous development of the midgut provides a basis for understanding the pathophysiology and the clinical presentation of malrotation and malrotation complicated by volvulus. In this essay, the radiologic findings of malrotation and volvulus are reviewed and illustrated with particular attention to the child with equivocal imaging findings.
204 citations
TL;DR: The clinical manifestations and upper GI tract findings of malrotation in older children and adults are less specific than are those in younger patients, and for this reason diagnosis of the condition may be more difficult.
Abstract: Intestinal malrotation, which is defined by a congenital abnormal position of the duodenojejunal junction, may lead to midgut volvulus, a potentially life-threatening complication. An evaluation for malrotation is part of every upper gastrointestinal (GI) tract examination in pediatric patients, particularly neonates and infants. Although the diagnosis of malrotation is often straightforward, the imaging features in approximately 15% of upper GI tract examinations are equivocal and lead to a false-positive or false-negative interpretation. The clinical manifestations and upper GI tract findings of malrotation in older children and adults are less specific than are those in younger patients, and for this reason diagnosis of the condition may be more difficult. Successful differentiation between a normal variant and malrotation requires the use of optimal techniques in acquiring and interpreting the upper GI series. Familiarity with the upper GI series appearance of both normal and abnormal anatomic variants allows the radiologist to increase both diagnostic accuracy and confidence in the diagnosis of malrotation.
201 citations
TL;DR: In low intestinal obstruction, ultrasonography (US) may help differentiate between small bowel obstruction and colonic obstruction, and computed tomography (CT) and magnetic resonance (MR) imaging can provide superb anatomic detail and added diagnostic specificity.
Abstract: Congenital anomalies of the gastrointestinal tract are a significant cause of morbidity in children and, less frequently, in adults. These abnormalities include developmental obstructive defects of...
165 citations
TL;DR: Complications included short gut, sepsis, feeding difficulties, pneumonia, small bowel obstruction, and other (15).
Abstract: Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.
162 citations