The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation

Yousefzadeh, David K.

doi:10.1007/s00247-008-1116-2

Cited by 97 publications

(42 citation statements)

References 24 publications

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“…They proposed that the utilization of gradual compression to obtain transverse and sagittal images of the aortomesenteric angle could demonstrate truly normal rotation if D3 was visualized between the aorta and the SMA. Senior pediatric radiologists with over 26 years of combined experience performed the study that affirmed the use of ultrasound over upper gastrointestinal series recommended by Yousefzadeh et al [12] two years earlier based on his own series of pediatric cases.…”

Section: Imaging Modalitiesmentioning

confidence: 80%

“…One author touts that ultrasonographic imaging in the hands of an experienced technician may demonstrate a retromesenteric D3, which alone can prove that a patient "will not have malrotation and will not develop midgut volvulus [12] ". Menten et al [11] support this assertion, describing a graded compression-technique to demonstrate positioning between the SMA and aorta.…”

Section: Current Controversiesmentioning

confidence: 99%

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Malrotation: Current strategies navigating the radiologic diagnosis of a surgical emergency

Tackett

Muise

Cowles

2014

WJR

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The most accurate and practical imaging algorithm for the diagnosis of intestinal malrotation can be a complex and sometimes controversial topic. Since 1900, significant advances have been made in the radiographic assessment of infants and children suspected to have anomalies of intestinal rotation. We describe the current methods of abdominal imaging of malrotation along with their pros and cons. When associated with volvulus, malrotation is a true surgical emergency requiring rapid diagnosis and treatment. We emphasize the importance of close cooperation and communication between radiology and surgery to perform an effective and efficient diagnostic evaluation allowing prompt surgical decision making. Key words: Malrotation; Midgut volvulus; Treitz; Ladd; Heterotaxy; Infant Core tip: Malrotation, especially when associated with midgut volvulus, is a surgical emergency that must be astutely recognized, quickly diagnosed, and emergently treated operatively. While the diagnosis depends heavily on clinical acumen and suspicion, radiologic imaging is critical in determining which patients need surgery. Surgeons and radiologists must cooperate and communicate effectively during the radiographic evaluation of a child with malrotation. Additionally, the algorithm for imaging malrotation must be adapted based upon the tools and staff available at any given institution. INTRODUCTIONSurgeons are often consulted for evaluation of pediatric abdominal problems presenting to the emergency department. It is common for these patients to be evaluated by radiographic imaging in addition to a focused history and physical examination. The surgeon and radiologist must always have a particularly high-level of suspicion in cases of possible malrotation that may require emergency surgery after evaluation. CASE PRESENTATIONA 5-day-old full term male infant presents to the emergency department with continuous bilious non-bloody vomiting and irritability after his last three feeds. He was born by normal spontaneous vaginal delivery without complications and was noted to be breast-feeding well prior to discharge on day-of-life 2; he continued breastfeeding and passing stools at home for the past 4 d until this evening. On exam, his abdomen is minimally distended and he is crying constantly. The clinical picture suggests an obstruction distal to the ampulla of Vater,

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Section: Imaging Modalitiesmentioning

confidence: 80%

Section: Current Controversiesmentioning

confidence: 99%

Malrotation: Current strategies navigating the radiologic diagnosis of a surgical emergency

Tackett

Muise

Cowles

2014

WJR

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“…US has been proposed as an alternative to upper GI in the evaluation for malrotation [69,70]. The hypothesis that demonstration of the 3rd portion of the duodenum between the SMA and aorta documents normal bowel rotation has been challenged by several papers [71].…”

Section: Ultrasoundmentioning

confidence: 99%

Congenital duodenal obstruction: causes and imaging approach

2016

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Bilious emesis is a common cause for evaluation in pediatric radiology departments. There are several causes of congenital duodenal obstruction, most of which require elective surgical correction, but the potential of malrotation with midgut volvulus demands prompt imaging evaluation. We review the various causes of congenital duodenal obstruction with an emphasis on the approach to imaging evaluation and diagnosis.

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“…Recently, sonographic display of the third portion of the duodenum between the SMA and aorta has been recommended as a possible method for locating malrotation [13]. Besides, position of SMV relative to SMA and a clockwise mesenteric vascular swirl-like appearance on CT findings are useful for diagnosis of malrotation [14,15]. Among the whirlpool signs observed in our case, one proved to be a normal finding (Fig.…”

Section: Discussionmentioning

confidence: 58%

Small Bowel Obstruction Caused by an Aberrant Congenital Band in a Child

Kwak

Kang

Kim

et al. 2012

Pediatr Gastroenterol Hepatol Nutr

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Small bowel obstruction due to congenital band is not only rare in children, but also difficult to diagnose, because common symptoms such as vomiting and abdominal pain are observed in patients. In order to prevent a fatal result, an anomalous congenital band should be considered in the discriminative diagnosis of intestinal obstruction in children who have no previous experience of operation or intraperitoneal inflammation. This report presents a 4-year-old boy who was admitted with abdominal pain and nonbilious vomiting for a day. The initial suspicion was for acute gastroenteritis. However, after further investigation and performance of surgery, the intestinal obstruction associated with a congenital band was confirmed. No recurrence was observed during the 8-month follow-up period. Thus early confirmation based on radiologic study is a crucial factor for the diagnosis of small bowel obstruction caused by a congenital band. (Pediatr Gastroenterol Hepatol Nutr 2012; 15: 188∼192)

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The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation

Cited by 97 publications

References 24 publications

Malrotation: Current strategies navigating the radiologic diagnosis of a surgical emergency

Malrotation: Current strategies navigating the radiologic diagnosis of a surgical emergency

Congenital duodenal obstruction: causes and imaging approach

Small Bowel Obstruction Caused by an Aberrant Congenital Band in a Child

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