Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery.

Weinberger, Ed; Winters, William D.; Liddell, Robert M.; Rosenbaum, DM; Krauter, D

doi:10.2214/ajr.159.4.1529850

Cited by 104 publications

(40 citation statements)

References 3 publications

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“…The relationship between malrotation and other anomalies was demonstrated in the current study and some other studies (14,15). In the present study, nearly half of the cases had malrotation-associated anomalies.…”

Section: Discussionsupporting

confidence: 87%

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

2018

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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.

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Section: Discussionsupporting

confidence: 87%

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

2018

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“…Moreover, there are cases in which diagnosis was not followed by surgical correction, with the consequent later emergency surgery because of total or partial volvulus [41,42]. We consider that when there is a clinical suspicion, a scan with Doppler ultrasound is recommended, looking for the inversion of the mesenteric vessels-the so-called whirlpool sign [43,44]. Positive Doppler ultrasound findings are reliable even in the neonate, with an 85% accuracy rate in cases of complete malrotation, and they are useful to indicate other, more reliable, tests [45].…”

Section: Discussionmentioning

confidence: 99%

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

et al. 2007

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The malrotation and no well fixation anomalies of the digestive tract is also frequent in older child, young and adult, with characteristic and specific clinical presentation. Actually, the diagnostic and treatment seem to be late, after suffering prolonged symptoms and/or in emergency. We present nine cases of anomalies in the embryonic development of the digestive tract which were diagnosed and treated in infants or young, all above 2 years old. Eight cases were of more or less complete intestinal malrotation; one of them was a complete malrotation with an intrinsic duodenal stenosis associated (no bands of Ladd) and another one was a right paramesocolic hernia, always accompanied by malrotation. The association with other extra-digestive anomalies, especially urological, was 70%. The predominant symptom was intermittent abdominal pain (IAP)-80%-sometimes accompanied by vomiting (35%) and episodes of diarrhoea (25%). In all the cases, while the clinical background was early, diagnosis was late. Indeed, in 60% of the cases diagnosis was made intra-operatively in emergency surgical interventions. The imaging procedures employed were scanning and Doppler ultrasound, CT scan, and contrast gastrointestinal series (GIS). Up to 30% of errors in interpretation occurred, although they were eventually corrected with other tests. The most reliable diagnostic procedures were GIS and CT scan with contrast, although partial interpretation errors occurred with the latter procedure. Surgery was essential in 80% of the pre-operative cases, and in another two it was required as a preventative measure. Post-operatively, there was notable persistence of SBS in the cases of intestinal necrosis, and of other lesser symptoms in the rest. We conclude that: intestinal malrotations and malfixations are still being diagnosed very late, with serious systemic consequences such as intestinal obstructions or necroses, and prolonged clinical suffering. This could all be avoided if more attention were paid to the digestive symptoms associated with IAP, and to subocclusion or other abdominal phenomena (distension,...), together with, in the case of doubt about the findings with the previous procedures, the opportune imaging tests (e.g., abdominal Doppler ultrasound, CT scan with contrast, and barium GIS). Unlike other authors, we consider that the morbidity/mortality associated with cases of late diagnosis of these anomalies is high, and calls for earlier surgical treatment.

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“…Ultrasonography has the potential benefits of portability and lack of radiation. Several studies have suggested that inversion of the superior mesenteric vessels, (ie, the SMV to the left of the SMA), is diagnostic of malrotation in 100% of the cases [2][3][4]. In those cases where the SMV lies anterior to the SMA the incidence of malrotation decreases to 25% to 28% [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with abnormal anatomy are taken expeditiously to the operating room. Some authors have recently described abnormalities in the orientation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) on ultrasonography (US) in patients with malrotation and have suggested that this may be an alternative way to establish this diagnosis [2][3][4]. However, it is less clear whether US is adequate to rule out malrotation.…”

mentioning

confidence: 99%

Is ultrasonography a good screening test for intestinal malrotation?

Orzech¹,

Navarro²,

Langer³

2006

Journal of Pediatric Surgery

132

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Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery.

Cited by 104 publications

References 3 publications

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

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

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

Is ultrasonography a good screening test for intestinal malrotation?

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