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[Malrotation and Midgut Volvulus in Children: Diagnostic Approach, Imaging Findings, and Pitfalls]
Insights
Malrotation and midgut volvulus are critical infant emergencies. Ultrasonography is a preferred, radiation-free screening tool for rapid diagnosis of these conditions.
Area of Science:
- Pediatric Surgery
- Medical Imaging
- Gastroenterology
Context:
- Malrotation and midgut volvulus are life-threatening surgical emergencies in neonates.
- Classic symptom is bilious vomiting; older children may present with abdominal pain.
- Associated anomalies include annular pancreas and preduodenal portal vein.
Purpose:
- To discuss key imaging findings and diagnostic approaches for malrotation and midgut volvulus.
- To highlight diagnostic pitfalls in pediatric cases.
- To emphasize the importance of prompt and accurate diagnosis.
Summary:
- Malrotation with midgut volvulus requires immediate diagnosis and intervention.
- Imaging modalities include upper GI series, ultrasonography, and CT.
- Ultrasonography is favored for rapid, accurate, radiation-free screening in children.
Impact:
- Facilitates timely diagnosis and treatment of pediatric surgical emergencies.
- Reduces risks associated with delayed diagnosis, such as bowel ischemia.
- Provides a valuable resource for clinicians managing malrotation and midgut volvulus.
Abstract:
Malrotation and midgut volvulus are surgical emergencies that commonly occur within the first month of life. The classic symptom is acute bilious vomiting, while nonspecific symptoms such as recurrent abdominal pain may be present in older children. Malrotation can be associated with duodenal obstruction caused by an abnormal peritoneal fibrous band or congenital anomalies, such as an annular pancreas or a preduodenal portal vein. Volvulus can lead to bowel ischemia and a life-threatening condition, thus prompt and accurate diagnosis is crucial. Diagnosis can be made through upper gastrointestinal series, ultrasonography, and CT, with ultrasonography being preferred as a screening tool due to its rapid and accurate diagnosis, without radiation exposure, in children. This pictorial essay discusses the key imaging findings and diagnostic approaches for malrotation and midgut volvulus, as well as diagnostic pitfalls based on actual cases.
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