Intestinal Malrotation in Children: A Problem-solving Approach to the Upper Gastrointestinal Series

Abstract

Intestinal malrotation, which is defined by a congenital abnormal position of the duodenojejunal junction, may lead to midgut volvulus, a potentially life-threatening complication. An evaluation for malrotation is part of every upper gastrointestinal (GI) tract examination in pediatric patients, particularly neonates and infants. Although the diagnosis of malrotation is often straightforward, the imaging features in approximately 15% of upper GI tract examinations are equivocal and lead to a false-positive or false-negative interpretation. The clinical manifestations and upper GI tract findings of malrotation in older children and adults are less specific than are those in younger patients, and for this reason diagnosis of the condition may be more difficult. Successful differentiation between a normal variant and malrotation requires the use of optimal techniques in acquiring and interpreting the upper GI series. Familiarity with the upper GI series appearance of both normal and abnormal anatomic variants allows the radiologist to increase both diagnostic accuracy and confidence in the diagnosis of malrotation.

Neonatal small bowel obstruction due to malrotation: a clinical study

“…Applegate et al, published 7 keys for obtaining an accurate upper GI contrast series for diagnosis of malrotation. 7 Symptoms of malrotation in a newborn are basically due to volvulus or Ladd's bands causing duodenal obstruction. Most of the studies emphasize that when neonates present with symptoms of malrotation they are at a greater risk of midgut volvulus.…”

Malrotación intestinal con vólvulo, asociada a hiperglucemia grave por estrés

“…El diagnóstico se realiza con una seriada contrastada esófago-gastro-duodenal. 9,12 El tratamiento es quirúrgico, se realiza la operación de Ladd para prevenir vólvulos recurrentes y la mortalidad de este procedimiento es menor al 3%. 13 n BIBLIOGRAFÍA…”

A Rare Cause of Acute Abdomen in Adults: Intestinal Malrotation

“…It occurs predominantly in infants and rarely in adults (2,3). However, adult-age midgut malrotation is difficult to diagnose and should be kept in mind in differential diagnosis of acute abdomen due to its nonspecific presentation.…”