The efficiency of sonography in diagnosing volvulus in neonates with suspected intestinal malrotation

Abstract

This study is to prospectively evaluate the efficiency of sonography for volvulus diagnosis in neonates with clinically suspected intestinal malrotation.A total of 83 patients with suspected intestinal malrotation who underwent detailed abdominal sonography and upper gastrointestinal contrast study were included. Malrotation was characterized by inversion of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in sonographic examination. The “whirlpool sign” of Color Doppler Sonography was recognized as a characteristic for malrotation with volvulus. The degrees of rotation of the SMV winding around SMA were also detected by sonography. Surgery was performed in patients with sonography diagnosed malrotation.A total of 39 patients were sonographically diagnosed as malrotation which was subsequently confirmed by surgery. The sensitivity and positive predictive value of the sonographic diagnosis were both 100% (39/39). The sensitivity, specificity and accuracy of “whirlpool sign” for the detection of midgut volvulus were 95.2% (20/21), 88.9% (16/18), and 92.3% (36/39), respectively. Greater degrees of rotation (equal or greater than 720°) showed higher risk (odds ratio, 5.0; P < .01) for intestinal necrosis occurrence.Sonography is more accurate in diagnosing suspected malrotation than upper gastrointestinal contrast study. Specific sonographic “whirlpool sign” related to volvulus may be used as a potential indicator for intestinal necrosis. In addition, sonography can exclude malrotation and may help the diagnosis of other diseases, such as annular pancreas and duodenal atresia.

Use of ultrasound findings to predict bowel ischemic changes in pediatric patients with intestinal volvulus

“…A previous study reported that the incidence of intestinal necrosis in cases with rotations of 720° or greater was 33.3%, whereas the incidence in cases with rotations of less than 720° was 6.7% . In our study, 1 of 4 cases (25%) with rotations of 720° or greater needed bowel resection, and 4 of 27 cases (15%) with rotations of less than 720° did not need bowel resection.…”

“…In these 4 cases, 2 cases needed bowel resection due to tumor lesions and not intestinal necrosis. Therefore, our result was consistent with the previous report …”

“…Various imaging findings have been reported as predictors of intestinal disorders . On the basis of these previous findings, we reviewed the following US findings: (1) superior mesenteric artery collapse (Figures ); (2) ascites (Figure ); (3) echogenic ascites (Figure ); (4) portal venous gas; and (5) free air.…”

“…To date, only a single report has focused on the use of US findings to predict intestinal bowel necrosis and evaluated the degree of intestinal twist . On computed tomography, the presence of occlusion of the superior mesenteric artery can be a predictive factor for intestinal necrosis .…”

“…8,9 Although computed tomography is usually performed in adult patients with suspected bowel necrosis, ultrasound (US) imaging is a useful examination that can be conducted at a patient's bedside and is usually the first examination for pediatric patients with suspected volvulus. 6,7,[13][14][15] To date, only a single report 16 has focused on the use of US findings to predict intestinal bowel necrosis and evaluated the degree of intestinal twist. 16 On computed tomography, the presence of occlusion of the superior mesenteric artery can be a predictive factor for intestinal necrosis.…”