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Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice
Kevin Wong1, Dane Van Tassel2, Justin Lee3
1University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Children's Hospital, Little Rock, AR.
Purpose:
To assess the diagnostic accuracy of limited abdominal ultrasound (US) examination for midgut volvulus (MGV) and to evaluate how clinical practice has changed in a free-standing children's hospital leading to the near obsolescence of upper GI (UGI) studies for the diagnosis of MGV.
Materials And Methods:
All patients with suspected MGV who underwent abdominal US during 2016-2017 were identified using keyword search tools in the radiology information system. Retrospective, blinded image review was performed by a certificate of added qualification (CAQ), board certified pediatric radiologist. US images were evaluated for the presence of the superior mesenteric artery (SMA) cutoff sign and twisting of the bowel and mesentery around the SMA (whirlpool sign). The results were compared with the operative reports.
Results:
195 US studies were performed from 2016 to 2017. The most common presentations were vomiting (44%), abdominal pain (7%), and suspected malrotation (10%) 195 US studies were reviewed, of which 16 were nondiagnostic. The remaining 179 diagnostic studies showed MGV in 14 patients. Those 14 patients were surgically explored and confirmed to have midgut volvulus. 7 of the 16 nondiagnostic US studies were further evaluated with UGI examination with 1 patient demonstrating malrotation without volvulus, which was confirmed at surgery. 2 had CT exams which were normal. 4 were followed clinically. The remaining 3 patients went to surgery, all of which did not show MGV. There were 164 negative US, none of whom went to surgery. US was diagnostic in 92% of patients and when diagnostic the positive and negative predictive values of US were 100%.
Conclusion:
Limited abdominal US is a highly accurate examination for the diagnosis of midgut volvulus. UGI exposes patients to ionizing radiation and should be reserved for patients in whom US is nondiagnostic or inconclusive.
Type Of Study:
Retrospective review.
Level Of Evidence:
Level 3.
Insights
Limited abdominal ultrasound (US) is highly accurate for diagnosing midgut volvulus (MGV). Upper GI studies, exposing patients to radiation, should be reserved for inconclusive US cases.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
Background:
- Midgut volvulus (MGV) is a surgical emergency requiring prompt diagnosis.
- Upper GI (UGI) studies have traditionally been used but involve radiation exposure.
- The role of limited abdominal ultrasound (US) in diagnosing MGV needs clear assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of limited abdominal US for MGV.
- To assess the shift away from UGI studies towards US in a pediatric hospital setting.
Main Methods:
- Retrospective review of 195 abdominal US studies performed for suspected MGV between 2016-2017.
- Blinded review of US images by a pediatric radiologist, looking for SMA cutoff and whirlpool signs.
- Comparison of US findings with operative reports.
Main Results:
- US was diagnostic in 92% of cases, with 100% positive and negative predictive values when diagnostic.
- MGV was confirmed in 14 patients via surgery after positive US findings.
- 164 negative US studies correctly ruled out MGV, with no subsequent surgeries.
Conclusions:
- Limited abdominal US is a highly accurate and preferred diagnostic tool for MGV in children.
- UGI studies should be reserved for cases where US is nondiagnostic or inconclusive, minimizing radiation exposure.
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