Diagnostic accuracy of upper gastrointestinal series in children with suspected intestinal malrotation

Girolamo, Mattioli; Emanuela, Gallo; Yu, Wong Michela Cing; Anna, Marzoli; Marta, Pongiglione; Grazia, Calevo Maria; Gandullia, Paolo; Arrigo, Serena; Stefano, Avanzini; Beatrice, Damasio Maria

doi:10.1007/s13304-023-01559-8

Cited by 2 publications

(2 citation statements)

References 40 publications

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“…UGIs ( 28 , 33 , 34 ) can help make an early accurate diagnosis in different age groups. UGI examination is associated with a sensitivity of 54%–86.5% for detecting midgut volvulus ( 24 , 27 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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BackgroundIntestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.MethodsClinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.ResultsThe mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), p < 0.05 and p < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including in utero volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time (p < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).ConclusionsNon-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.

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Section: Discussionmentioning

confidence: 99%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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“…Despite efforts to move to an ultrasound diagnosis, the standard imaging technique for the diagnosis of malrotation and midgut volvulus in newborns with bilious vomiting remains the fluoroscopically guided upper gastro-intestinal series (UGIS) [1][2][3][4][5][6]. Malrotation is a congenital condition associated with abnormal bowel rotation and can include both small and large intestines.…”

Section: Introductionmentioning

confidence: 99%

Quality and Diagnosis on the Lateral View of Pediatric Upper Gastro-Intestinal Series

Venkatakrishna,

Elsingergy,

Calle-Toro

et al. 2024

Children

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Background: The standard imaging technique for the diagnosis of intestinal malrotation remains the upper gastro-intestinal series (UGIS). The lateral view is promoted as important for making a diagnosis. For this, the lateral view should be of adequate quality, and radiologists must know the normal appearance as well as the appearance of duodenal variants, as misdiagnosis may lead to unnecessary surgery. Objective: We aimed to evaluate the quality, findings including the prevalence of the ”descending staircase” configuration and its correspondence to a diagnosis of duodenum redundum. Materials and Methods: This was a retrospective study and was conducted in a large tertiary children’s hospital in the United States. A retrospective review of UGI fluoroscopy exams in children aged ≤ 18 years between January and December 2018 was performed by a pediatric radiologist. First, the lateral view images/cine-loops were assessed independently, followed by the anteroposterior (AP) view. The studies which were designated to have an adequate lateral view were evaluated for configuration of the duodenum and recorded as: normal, abnormal, or normal variant. Also, the presence of a descending staircase configuration was correlated with an AP view for a diagnosis of duodenum redundum. Results: A total of 26 children (26%) (males:16; females:10) with age range 0 to 16 years had adequate lateral views during UGI exams for inclusion. Of the 26, 18 (69%) were reported as normal, 7 (27%) were reported as having a descending staircase and 1 (4%) was reported as abnormal. The AP view demonstrated 2 abnormal studies (1 malrotation and 1 non-rotation), 6 duodenum redundum and 18 normal exams. The one abnormal lateral duodenum was confirmed as a non-rotation on AP view; the second patient with an abnormal AP view had a normal appearance on the lateral view. Conclusions: A total of 26% of UGI studies had adequate lateral views for interpretation. Of these, nearly a quarter (23%) demonstrated the descending stair-case sign corresponding to a diagnosis of duodenum redundum on the AP view. If the lateral view had been used alone, there would have been a missed diagnosis in one patient.

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Diagnostic accuracy of upper gastrointestinal series in children with suspected intestinal malrotation

Cited by 2 publications

References 40 publications

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Quality and Diagnosis on the Lateral View of Pediatric Upper Gastro-Intestinal Series

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