The radiologist says malrotation: does the surgeon operate?

Dilley, A.; Pereira, John; Shi, Enyi; Adams, Susan; Kern, I. B.; Currie, Bruce G.; Henry, Guy

doi:10.1007/s003830050012

Cited by 98 publications

(65 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In another study conducted in 2000, false negative malrotation results were observed in 15% of the cases using GI series evaluation (17). In a former study, contrast-enhanced evaluation of the upper gastrointestinal system detected malrotation in 41% of the patients, while assessment with barium enema led to detection of this diagnose in 34% of the patients.…”

Section: Discussionmentioning

confidence: 94%

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

2018

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 94%

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

2018

View full text Add to dashboard Cite

show abstract

“…CT scan can also identify these abnormal positions of the small bowel and the colon and the opposite positioning of the superior mesenteric vein, located on the left side of the artery. It may also be helpful in identifying acute obstruction 3,4 .…”

Section: Discussionmentioning

confidence: 99%

“…However, sometimes this study can be normal. A double-contrast barium enema can show the abnormal cecal location, just below the liver, near the midline, and the entire colon located laterally letter to the Editor to the spine on the left side 3 . CT scan can also identify these abnormal positions of the small bowel and the colon and the opposite positioning of the superior mesenteric vein, located on the left side of the artery.…”

Section: Discussionmentioning

confidence: 99%

Procedimento de ladd para má rotação intestinal no adulto: relato de caso

Kotze¹,

Martins²,

Rocha³

et al. 2011

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

“…In other patients, a variable course of the disease with various radiological pattern of intestinal aeration on subsequent films may be responsible for inconclusive interpretation and eventually diagnostic delay. Currnetly, in most centers upper GIT contrast study is regarded as the most important diagnostic modality in children with symptoms of malrotation (5,14,22) The patients presenting with unequivocal acute peritoneal symptoms are the exception to this rule. A location of the duodeno-ileal junction to right of midline is a classical finding, but there are other radiological features suggestive of this anomaly (4, 15,21,22).…”

Section: Discussionmentioning

confidence: 99%

“…Currnetly, in most centers upper GIT contrast study is regarded as the most important diagnostic modality in children with symptoms of malrotation (5,14,22) The patients presenting with unequivocal acute peritoneal symptoms are the exception to this rule. A location of the duodeno-ileal junction to right of midline is a classical finding, but there are other radiological features suggestive of this anomaly (4, 15,21,22). On the other hand, an upper contrast study is not associated with 100% accuracy and in some cases may not reveal any abnormality.…”

Section: Discussionmentioning

confidence: 99%

Clinical Spectrum of Malrotation in Children

Bagłaj¹,

Patkowski²,

Czernik³

et al. 2007

Polish Journal of Surgery

View full text Add to dashboard Cite

The aim of the study. Retrospective analysis of diagnosis, surgical management and final outcome of malrotation in children. Material and methods. Clinical charts, operative notes and imaging studies of all children operated on for malrotation in years 1985-2005 were studied. Children in whom malrotation was diagnosed incidentally during an operation performed because of other indications were excluded. A detailed analysis of the presentation, signs and symptoms, clinical course, and diagnostic modalities used in affected patients was carried out. Anatomical variants of malrotation and their operative management were evaluated as well. Results. In the period from 1985 to 2005 forty children with malrotation were treated. There were 25 neonates, 10 infants and 5 children older than 1 year of age. Thirty-five children were referred directly as inpatients from other hospitals. An acute or urgent clinical presentation was noted in 32 children, while in 8 patients as the presentation was subacute or chronic. In all children bile-stained vomiting was the predominant sign. In 21 children, ileus was the referral diagnosis. Only 5 children were admitted with an established diagnosis of malrotation. In six cases duodenal atresia was suspected. Delay in diagnosis of congential intestinal anomaly was identified in 15 children. In five newborns, the initial diagnosis was enterocolitis. Four other patients, including one infant and three older children, were admitted to the pediatric departments several times before receiving the final diagnosis. In 18 children, the only pre-operative imaging was abdominal plain X-ray. In 22 patients, contrast studies were performed as well. All children underwent operative management. Ladd's syndrome was diagnosed in 16 patients, and in another 7 children was associated with small bowel torsion. Isolated small bowel torsion was noted in 7 patients. In 6 patients, midgut volvulus with strangulation was found intraoperatively. Two children with typical anatomical features of non-rotation presented with recurrent episodes of ileus. In single cases, mesocolic internal hernia and sigmoid torsion were noted. 5 children died postoperatively, four of whom had midgut volvulus with massive small bowel necrosis. Conclusions. Malrotation is a rare congenital anomaly that can present with a wide anatomical and clinical spectrum but should be considered in the differential diagnosis for all children, regardless of age, manifesting with bile-stained vomiting. Suspicion of malrotation seems to be an obvious indication for referral to a tertiary pediatric surgical department where necessary imaging should be undertaken with the participation of an experienced radiologist. Regardless of its clinical presentation, malrotation should be considered an unequivocal indication for surgical treatment due to risk of midgut volvulus with its serious sequelae.

show abstract

The radiologist says malrotation: does the surgeon operate?

Cited by 98 publications

References 27 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

Procedimento de ladd para má rotação intestinal no adulto: relato de caso

Clinical Spectrum of Malrotation in Children

Contact Info

Product

Resources

About