Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice

Wong, Kenny; Tassel, Dane Van; Lee, Justin; Buchmann, Robert F.; Riemann, Monique; Egan, Craig; Youssfi, Mostafa

doi:10.1016/j.jpedsurg.2020.04.012

Cited by 21 publications

(9 citation statements)

References 13 publications

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“…Wong et al . also found that US had a positive predictive value of 100% when diagnosing M/V in those aged 0–20 years 18 . A total of 91% were under 1 year, with 50% of those under 1 month.…”

Section: Discussionmentioning

confidence: 85%

“…17 Wong et al also found that US had a positive predictive value of 100% when diagnosing M/V in those aged 0-20 years. 18 A total of 91% were under 1 year, with 50% of those under 1 month. Notably in the 164 patients presenting with vomiting or suspected malrotation who had a negative US did not proceed to surgery and were only followed for 1 month without event.…”

Section: Discussionmentioning

confidence: 97%

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How should the neonatal retrieval team respond to the neonate referred with bilious vomiting?

Nundeekasen

Dalrymple

Moustafa

et al. 2021

J Paediatrics Child Health

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Aim Bilious vomiting (BV) in the neonatal period may herald malrotation with life‐threatening volvulus. In New South Wales, contrast fluoroscopy is not available in non‐tertiary paediatric centres; therefore, transfer is required. An infant with BV referred to Newborn and Paediatric Emergency Transport Service is prioritised for urgent retrieval to a surgical centre for contrast fluoroscopy and paediatric surgical review. This study analysed how many neonates with BV needed retrieval to prevent bowel loss or to save one life and to identify predictors of malrotation and/or volvulus. Methods All neonatal referrals (<29 days) to Newborn and Paediatric Emergency Transport Service between 31 July 2014 and 31 July 2020 with BV or aspirates were examined. Data on time of onset of BV, time of call for retrieval, vital signs, lactate level and blood glucose at referral, time of arrival at the surgical centre and outcome were analysed. Results Of 391 neonates referred with BV, 113 (28.9%) had a surgical cause and 31 (7.9%) had a time‐critical malrotation and/or volvulus. All 31 neonates were well at referral with normal vital signs including three neonates who subsequently died. Lactate levels at referral (1–7.5 mmol/L) were not predictive of outcome. The odds of a time‐critical diagnosis increased with every day of age (odds ratio = 1.097), heart rate >140 (P = 0.04) and decreased for each kilogram of birthweight (odds ratio 0.475; confidence interval 0.294–0.768). Conclusions Neonates with BV require urgent referral to paediatric surgery and contrast fluoroscopy. Thirteen urgent transfers are required to preserve the bowel integrity and life in one baby.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 97%

How should the neonatal retrieval team respond to the neonate referred with bilious vomiting?

Nundeekasen

Dalrymple

Moustafa

et al. 2021

J Paediatrics Child Health

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show abstract

“…have been previously outlined in the literature, and have advocated the search for an alternative readily available screening tools. 6,15,16 The classical presentation of malrotation formerly described is of an otherwise very well infant with BV and no abnormal clinical signs. Where, in cases of MGV gastrointestinal bleeding, abdominal tenderness and severe systemic disturbance can be associated.…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal series in healthy neonates with bilious vomiting—is it still obvious? A retrospective observational study

et al. 2023

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AimDemand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need to rule out malrotation and midgut volvulus (MGV). We aimed to examine predictive value of clinical parameters in the management of healthy neonates presenting with BV and re‐assess the role of UGI in their management.MethodsA retrospective cohort study including medical, imaging and surgical data of neonates who underwent UGI due to BV.ResultsA total of 157 term neonates, eight neonates (5.1%) had confirmed surgical diagnosis of malrotation, five of them had malrotation with MGV, including two neonates who underwent extensive intestinal resection due to necrosis. Neonates with a combination of abnormal plain radiograph and abdominal distention had 10 times higher odds of malrotation diagnosis, adjusting for age at first BV (p = 0.017). Neonates with a combination of abnormal plain radiograph, abdominal distention and abdominal tenderness had 25 times higher odds of MGV (p = 0.002).ConclusionThis study reaffirms the role of UGI as the current main diagnostic tool for malrotation and MGV. Physical examination and plain radiograph findings can help but cannot substitute UGI study.

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“…If these two master sonographers could not, how could the rest of us? Some practices, mostly outside the United States, have further pursued US for the diagnosis of malrotation [3][4][5][6][7][8][9][10][11][12]. Some have achieved substantial success.…”

mentioning

confidence: 99%

“…Some have achieved substantial success. Most notable in the United States has been the group at Phoenix Children's Hospital [12]. In their hands, US was diagnostic in 92% of 195 patients, and, when diagnostic, both the negative and positive predictive values were 100% [12].…”

mentioning

confidence: 99%

Ultrasound for malrotation and volvulus: has the time come?

Strouse

2021

Pediatr Radiol

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Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice

Cited by 21 publications

References 13 publications

How should the neonatal retrieval team respond to the neonate referred with bilious vomiting?

How should the neonatal retrieval team respond to the neonate referred with bilious vomiting?

Upper gastrointestinal series in healthy neonates with bilious vomiting—is it still obvious? A retrospective observational study

Ultrasound for malrotation and volvulus: has the time come?

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