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10:02
State of the Art Cranial Ultrasound Imaging in Neonates
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.
Journal of Pediatric Surgery
|May 9, 2006
Summary
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.
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