What is the role of an upper GI series in the workup of intestinal malrotation?

Updated: Dec 19, 2018
  • Author: Denis D Bensard, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD  more...
  • Print
Answer

Upper GI series is the criterion standard to diagnose intestinal malrotation, with a sensitivity of 93-100%. However, upper GI but should only be obtained in patients who are hemodynamically stable. [26, 27, 28]

Normal rotation is present if the duodenal C-loop crosses the midline and places the duodenojejunal junction to the left of the spine at a level equivalent or superior to the pylorus. If the contrast ends abruptly or tapers in a corkscrew pattern, midgut volvulus or some other form of proximal obstruction may be present. Barium is the contrast of choice in patients who are stable or have chronic symptoms

Contrast studies may not be possible in patients who are actively vomiting or are otherwise unstable and need immediate surgical exploration. Water-soluble agents should be used if the study must be performed prior to emergent operative intervention. See the image below.

In this upper GI series with abnormal results, the In this upper GI series with abnormal results, the duodenum does not cross the midline, and the small bowel is present only in the right side of the abdomen.

In this upper GI series with abnormal results, the duodenum does not cross the midline, and the small bowel is present only in the right side of the abdomen.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!