Diagnostic Value of Ultrasound and Gastrointestinal Series Findings in Detection of Pediatric Intestinal Malrotation

Abstract

Background: Clinical diagnosis of malrotation is difficult to achieve, especially in older children and adults as its nonspecific presentations at this stage are usually neglected leading to delayed diagnosis of these cases. Objectives: In this study, we aimed to evaluate the diagnostic values of ultrasound and upper gastrointestinal (GI) series in patients with suspected intestinal malrotation. Methods: This six-year cross-sectional, prospective study was conducted in Dr. Sheikh Children's Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from 2009 to 2015. Totally, 67 children (aged < 15 years) with clinical findings of intestinal malrotation who had evidence of malrotation in ultrasound or upper GI series were enrolled in the study. Results of radiological evaluation were compared to the final diagnosis of patients achieved from surgery. Data analysis was performed using SPSS software. Results: Of the 67 enrolled participants with clinical findings or suspected radiological signs of intestinal malrotation, about half (52.2%) were male. Patients were 2 days to 16 years (mean, 2.5 years) old. Associated anomalies were observed in 47.7% of cases. Sensitivity and specificity were 82.5% and 85.7%, respectively for GI series findings and 82.3% and 54.5%, respectively for ultrasound compared with surgical findings as a gold standard. Conclusions: Ultrasound has a similar diagnostic value compared to upper GI series. They are complementary examinations and negative ultrasound or GI series results do not necessarily rule out intestinal malrotation. Mesenteric vessels ultrasound could be used as an accurate diagnostic method for the detection of intestinal rotational disorders.

Mesenteric Vessel Abnormalities Detected With Sonography: A Possible Gateway to the Early Diagnosis of Various Gastrointestinal Anomalies

“…24 In previous work, specificity of sonography was noted as 54.5%, for diagnosis of a rotational anomaly. 9 The result of this study demonstrated some abnormalities besides rotational anomalies, which were noted in association with a mesenteric vessel anomaly. Some of these were the detection of a mass effect and diaphragmatic hernia and have been previously described.…”

“…12–18 UGI series have a sensitivity of 93% to 100% and a 15% false positive rate. 1,4,6,9,19 In addition, radiographic studies have problems such as radiation exposure and issues with correct positioning during the radiographic examination. 20 Radiographic barium enemas cannot also be used as a routine test for rotational abnormalities of the bowel and mesenteric vessels because 20% of cases with rotational abnormalities show normal cecum position.…”

“…7,11 However, the low specificity of sonography compared with the UGI series (54.5% vs 87%) in the detection of malrotation and midgut volvulus is due to the large list of differential diagnoses for mesenteric vessel abnormalities. 9 The specificity of sonography could be improved, in detecting intestinal rotational disorders, by closely examining the normal variations and it would reduce the list of differential diagnoses for mesenteric vessel abnormalities.…”

“…These two abnormal diagnostic results are used as an indicator for malrotation or volvulus, in pediatric sonography. [3][4][5][6][7][8][9][10] In previous studies, a sonographic abnormality of the mesenteric vessels has mostly been evaluated as a predictor of rotational anomaly of midgut and has rarely been used to evaluate other diseases and anomalies. 11 This study was aimed to evaluate other diseases associated with mesenteric vessel abnormalities in children, except for rotational gut anomalies.…”

“…These two abnormal diagnostic results are used as an indicator for malrotation or volvulus, in pediatric sonography. 3–10…”