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Is ultrasonography a good screening test for intestinal malrotation?
J Pediatr Surg. 2006 May; 41(5):1005-9.JP

Abstract

BACKGROUND

Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We aimed to determine the accuracy of this technique.

METHODS

All children undergoing both upper gastrointestinal series (UGI) and US for possible malrotation over a 3-year period were reviewed. Patients were excluded if US did not include SMV/SMA orientation or if the duodenojejunal flexure was not visualized on UGI.

RESULTS

Of 211 eligible patients, UGI and US were both normal in 62% and both abnormal in 15%. Forty-four had abnormal US and normal UGI (false positive, 21%), and 5 patients had normal US and abnormal UGI (false negative, 2%). Of these 5, none were found to have a short mesenteric base, which put them at risk for volvulus. Among abnormal ultrasounds, inversion of SMV/SMA and a "whirlpool" sign were more predictive for malrotation and volvulus than anterior/posterior orientation.

CONCLUSIONS

Ultrasonography is a good screening tool that effectively rules out malrotation at risk for volvulus. Children with an abnormal ultrasound should have an UGI or go to the operating room, depending on clinical findings.

Authors+Show Affiliations

Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada ON M5G 1X8.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16677901

Citation

Orzech, Neil, et al. "Is Ultrasonography a Good Screening Test for Intestinal Malrotation?" Journal of Pediatric Surgery, vol. 41, no. 5, 2006, pp. 1005-9.
Orzech N, Navarro OM, Langer JC. Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg. 2006;41(5):1005-9.
Orzech, N., Navarro, O. M., & Langer, J. C. (2006). Is ultrasonography a good screening test for intestinal malrotation? Journal of Pediatric Surgery, 41(5), 1005-9.
Orzech N, Navarro OM, Langer JC. Is Ultrasonography a Good Screening Test for Intestinal Malrotation. J Pediatr Surg. 2006;41(5):1005-9. PubMed PMID: 16677901.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is ultrasonography a good screening test for intestinal malrotation? AU - Orzech,Neil, AU - Navarro,Oscar M, AU - Langer,Jacob C, PY - 2006/5/9/pubmed PY - 2006/10/20/medline PY - 2006/5/9/entrez SP - 1005 EP - 9 JF - Journal of pediatric surgery JO - J. Pediatr. Surg. VL - 41 IS - 5 N2 - BACKGROUND: Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We aimed to determine the accuracy of this technique. METHODS: All children undergoing both upper gastrointestinal series (UGI) and US for possible malrotation over a 3-year period were reviewed. Patients were excluded if US did not include SMV/SMA orientation or if the duodenojejunal flexure was not visualized on UGI. RESULTS: Of 211 eligible patients, UGI and US were both normal in 62% and both abnormal in 15%. Forty-four had abnormal US and normal UGI (false positive, 21%), and 5 patients had normal US and abnormal UGI (false negative, 2%). Of these 5, none were found to have a short mesenteric base, which put them at risk for volvulus. Among abnormal ultrasounds, inversion of SMV/SMA and a "whirlpool" sign were more predictive for malrotation and volvulus than anterior/posterior orientation. CONCLUSIONS: Ultrasonography is a good screening tool that effectively rules out malrotation at risk for volvulus. Children with an abnormal ultrasound should have an UGI or go to the operating room, depending on clinical findings. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/16677901/Is_ultrasonography_a_good_screening_test_for_intestinal_malrotation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(05)01011-0 DB - PRIME DP - Unbound Medicine ER -