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Updated: Aug 8, 2026
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Published on: February 2, 2015
Is ultrasonography a good screening test for intestinal malrotation?
Neil Orzech1, Oscar M Navarro, Jacob C Langer
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada ON M5G 1X8.
Insights
Early diagnosis of intestinal malrotation is crucial to prevent midgut volvulus. Ultrasonography (US) accurately screens for malrotation, with abnormal findings like SMV/SMA inversion indicating higher risk.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Surgical Emergencies
Background:
- Intestinal malrotation can lead to life-threatening midgut volvulus.
- Abnormal superior mesenteric artery (SMA) and vein (SMV) orientation on ultrasonography (US) is associated with malrotation.
Purpose of the Study:
- To evaluate the accuracy of US in diagnosing intestinal malrotation by assessing SMA/SMV orientation.
Main Methods:
- Retrospective review of 211 children who underwent both US and upper gastrointestinal series (UGI) for suspected malrotation.
- Exclusion criteria included incomplete US (lacking SMV/SMA orientation) or UGI (lacking duodenojejunal flexure visualization).
Main Results:
- 62% of patients had normal US and UGI; 15% had abnormal findings on both.
- Abnormal US with normal UGI (false positive) occurred in 21%; normal US with abnormal UGI (false negative) occurred in 2%.
- SMV/SMA inversion and "whirlpool" sign on US were more predictive of malrotation and volvulus than vessel orientation.
Conclusions:
- Ultrasonography is an effective screening tool for ruling out malrotation with volvulus risk.
- Abnormal US findings warrant further investigation with UGI or immediate surgical consultation based on clinical presentation.
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.
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