Related Experiment Video
Updated: Oct 4, 2025
Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review
HaiThuy N Nguyen1,2, Oscar M Navarro3,4, David A Bloom5
1Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Houston, TX 77030.
Insights
Midgut volvulus with malrotation is a pediatric emergency. Ultrasound (US) offers a promising alternative to traditional fluoroscopy for prompt diagnosis, potentially reducing complications in children.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastrointestinal Radiology
Background:
- Midgut volvulus associated with malrotation presents a critical pediatric surgical emergency.
- Timely diagnosis is crucial to prevent bowel ischemia, necrosis, and associated mortality.
- Fluoroscopic upper gastrointestinal series has been the standard diagnostic tool, but ultrasound (US) use is growing.
Purpose of the Study:
- To detail the ultrasound findings of midgut malrotation and volvulus in pediatric patients.
- To provide practical guidance on acquiring and interpreting ultrasound images for these conditions.
- To compare the advantages and limitations of ultrasound versus fluoroscopy.
- To propose a framework for adopting ultrasound as a primary diagnostic method.
Main Methods:
- This is a narrative review of diagnostic imaging modalities for pediatric midgut malrotation and volvulus.
- The review focuses on ultrasound findings and compares them with fluoroscopic upper gastrointestinal series.
- It includes practical tips for ultrasound acquisition and interpretation based on clinical experience.
Main Results:
- Ultrasound demonstrates specific findings indicative of midgut malrotation and volvulus.
- Ultrasound offers potential advantages in speed and accessibility compared to fluoroscopy.
- Challenges and limitations of ultrasound in diagnosing these conditions are also discussed.
Conclusions:
- Ultrasound is an increasingly viable imaging modality for pediatric midgut malrotation and volvulus.
- With proper protocols and training, ultrasound can be considered for first-line diagnosis.
- Transitioning to ultrasound may improve diagnostic efficiency and patient outcomes.
Abstract:
Midgut volvulus in association with malrotation is a pediatric surgical emergency. Prompt and accurate diagnosis is necessary to avoid bowel ischemia and necrosis, thereby reducing morbidity and mortality. Historically, the fluoroscopic upper gastrointestinal series has been the preferred imaging modality for the evaluation of both midgut malrotation and volvulus, although the use of ultrasound (US) is increasing. In this Narrative Review, we describe the findings of midgut malrotation and volvulus on US, including practical tips for acquisition and interpretation; discuss the advantages and challenges of both imaging modalities; and propose a path and safeguards for possible transition to the use of US as the first-line modality for diagnosis based on our experience in imaging children with midgut malrotation and volvulus.
