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

Katherine Bergus1, Destiny Duvall2, Brittany Albers3

  • 1Nationwide Children's Hospital, Center for Surgical Outcomes Research and Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH 43205, USA.

Journal of Pediatric Surgery
|October 2, 2024
PubMed

Insights

A new fluoroscopic measurement, mesenteric base width to abdominal wall diameter ratio (MBW:AWD), accurately identifies intestinal rotational abnormality in infants. An optimal ratio of 0.55 can help guide management decisions for malrotation.

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.
Abstract

Keywords:
Intestinal rotational abnormalityMalrotationMesenteric base width

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