(Ultrasound Review) - The ultrasound features of neonatal intestinal malrotation are presented in the following study from Taiwan, published in the Journal of Ultrasound in Medicine.
Early diagnosis of intestinal malrotation is important. There is a high mortality due to midgut volvulus and consequential bowel necrosis, problems that are associated with malrotation. Thirty-one neonates were scanned because of suspected bowel malrotation and twenty were shown on ultrasound to have malrotation. A volvulus also was demonstrated in nine of the twenty with malrotation.
During ultrasound examination, 50ml of distilled water was introduced into the stomach via a nasogastric tube to distend the stomach, duodenum, and jejunum. This improved the duodenal visualization on ultrasound and aided diagnosis of dilation, edema (wall >2mm) and malrotation. The AP diameter of the SMV was measured above and below the level of the umbilicus. The distal SMV was considered dilated if its diameter was greater than that of the proximal SMV. Surgery proved all of the ultrasound findings to be correct.
When ultrasound showed inversion of the superior mesenteric artery and superior mesenteric vein, this led to a diagnosis of malrotation of the bowel. Using color Doppler the SMV was shown twisting around the SMA and this was described as the "whirlpool sign." Features used to identify a volvulus included duodenal dilation with tapering configuration, fixed midline bowel, and the whirlpool sign. These three signs each showed a sensitivity of 89% and a specificity of 92%, while dilation of the distal SMV showed a sensitivity of 56% and a specificity of 92%.
"In conclusion, ultrasonography provides good diagnostic results in neonatal intestinal malrotation," the authors said. "Specific sonographic features relating to volvulus should be evaluated as potential indicators of the need for an emergent operation."
J Ultrasound Med 2000; 19:371–376
Hsun-Chin Chao et al
Syh-Jae Lin, Dept. of Pediatrics, Chang Gung Children’s Hospital, 5-Fu Hsing Street, Kwei-Shan 333, Taoyuan, Taiwan
By Ultrasound Review
October 10, 2000
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