What is the role of ultrasonography in the workup of intestinal malrotation?

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

Ultrasonography is quickly becoming a useful imaging modality in infants and children with abdominal pain and has been used to accurately diagnose intestinal malrotation with or without midgut volvulus. [29, 30, 31]

In the hands of experienced ultrasonographers, ultrasonography has been shown to have false positive rate of 0% and a false negative rate of 0-30%. [32, 33]

Findings indicative of malrotation include inversion of the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV) and a retroperitoneal position of the duodenum after fluid bolus via a nasogastric tube. [32]

Other diagnostic findings include fixed midline bowel loops and duodenal dilation with distal tapering. The finding of the SMV coiled around the SMA is suggestive of intestinal volvulus The presence of ascites and thickened bowel wall were not found to be statistically significant predictors of malrotation with midgut volvulus


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