Mesenteric Base Width: Abdominal Wall Diameter Correlates With Intestinal Rotational Anomalies in Infants

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Gastroenterology

Background:

• Symptomatic intestinal malrotation necessitates prompt surgical intervention (Ladd procedure).
• Management of incidental or indeterminate malrotation findings varies, including observation or surgery.
• Fluoroscopic assessment of the duodenojejunal junction (DJJ) and ileocecal junction (ICJ) can inform clinical decisions, but validated algorithms are lacking.

Purpose of the Study:

• To evaluate the correlation between a novel fluoroscopic measurement, mesenteric base width standardized to abdominal wall diameter (MBW:AWD), and intraoperative anatomy in infants.
• To determine if the MBW:AWD ratio can accurately differentiate normal intestinal rotation from intestinal rotational abnormality (IRA).

Main Methods:

• Retrospective review of fluoroscopic studies in infants (<1 year) with identified DJJ and ICJ between 2013-2023.
• Exclusion of infants with congenital conditions causing intestinal nonrotation.
• Independent measurement of MBW (DJJ to ICJ) and maximal transverse abdominal wall diameter (AWD) by two radiologists.
• Calculation of the MBW:AWD ratio and comparison between normally rotated infants and those with IRA using statistical tests (Wilcoxon rank-sum, Kruskal-Wallis).
• Determination of the optimal MBW:AWD ratio cutoff using receiver operating characteristic (ROC) curve analysis.

Main Results:

• Fifty-eight infants were included: 22 with normal rotation and 36 with IRA.
• A significant difference in preoperative radiographic concern for malrotation was observed between groups (p < 0.0001).
• The median MBW:AWD ratio was significantly lower in infants with IRA (0.31) compared to those with normal rotation (0.65) (p < 0.0001).
• An optimal MBW:AWD ratio cutoff of 0.55 demonstrated high diagnostic accuracy (AUROC = 0.9578).

Conclusions:

• The MBW:AWD ratio is a reliable radiographic marker for distinguishing between normal intestinal rotation and IRA in infants.
• An MBW:AWD ratio of 0.55 serves as an effective cutoff for identifying IRA.
• Further validation is needed to establish the role of this ratio in managing incidental IRA or indeterminate findings on upper gastrointestinal (UGI) studies.