Intestinal malrotation

Midgut volvulus is the most dramatic consequence of intestinal malrotation. When present at birth, the classic finding on a plain film is partial obstruction of the duodenum, but evidence of complete obstruction may also be present. In such cases, it is impossible to distinguish midgut volvulus from... 

Carty HM (2002) Paediatric emergencies non-traumatic abdominal emergencies. Eur Radiol 12 2835-2848 Ceres L, Alonso I, Lopez P et al (1990) Ultrasound study of acute appendicitis in children with emphasis upon the diagnosis of retrocecal appendicitis. Pediatr Radiol 20 258-261 Chao HC, Kong MS, Chen JY et al (2000) Sonographic features related to volvulus in neonatal intestinal malrotation. J Ultrasound Med 19 371-376 Chinn DH, Millar El, Piper N (1987) Hemorrhagic cholecystitis. Sonographic and clinical presentation. J Ultrasound Med 6 313-317... 

Long FR, Kramer SS, Markowitz RI et al (1996) Radiographic patterns of intestinal malrotation in children. Radiographics 16 547-556... 

Pickhardt PJ, Bhalla S (2002) Intestinal malrotation in adolescents and adults spectrum of clinical and imaging features. AJR Am J Roentgenol 179 1429-143 Pierro A, Hall N (2003) Surgical treatments of infants with necrotizing enterocolitis. Semin Neonatol 8 223-232 Ping AJ, Blane CE, Carver KA (1998) Current prognosis in necrotizing enterocolitis with portal vein gas. Can Assoc Radiol J 49 237-240... 

Most important in these cases is to exclude conditions that are life-threatening for the patient. As intestinal malrotations may lead to bowel ischemia, which may subsequently lead to bowel necrosis, the patient s life is at risk when less than 3 in. of small bowel remain (Andrassy and Mahour 1981). 

In the case of duodenal obstruction with similar clinical signs as atresia, but with air distal to the duodenum, intestinal malrotation should be ruled out. 

The sign of an intestinal malrotation is sometimes recognizable on an abdominal plain film in which the small bowel will be located in the right upper abdomen. When this is observed, color Doppler sonography shows in 85% of the cases an abnormal position and course of the superior mesenteric artery with dextroposition to the superior mesen-... 

Fig. 5.4. An infant with intestinal malrotation on US. Abnormal position of the superior mesenteric arteria dextropositioned to the mesenteric vein...

Fig. 5.6. a UGI determines normal rotation by identifying the duodenojejunal junction (ligament of Treitz). b Intestinal malrotation demonstrated with a barium enema. Localization of jejunum in right upper quadrant. The duodenum does not cross the spine... 

Intestinal Malrotation 168 Duodenal Diverticulum 169 Duodenal Duplication 169 Preduodenal Portal Vein 170 Inflammatory Diseases 170 Peptic Disease and Its Complications 170 Crohn s Disease 171... 

Fig. 9.1. Nonrotation type of intestinal malrotation. CECT at the level of the pancreatic head shows right-sided contrast-filled small bowel loops, left-sided colon, and absence of the horizontal duodenum. Note an abnormal relationship of the superior mesenteric vessels and aplasia of the uncinate process of the pancreas...

Fig. 9.2. Type 11c of intestinal malrotation The horizontal duodenum passes anteriorly to the vertically oriented superior mesenteric vessels with a normally located colon in front of it. (Reprinted with permission from Zissin et al. 1999)...

The characteristic CT findings of intestinal nonrotation include abnormal orientation of the superior mesenteric vessels, aplasia or hypoplasia of the uncinate process of the pancreas, right-sided small bowel loops, a left-sided colon, and the absence of the horizontal part of the duodenum. Vertical or reversed location of the superior mesenteric vessels is, however, not specific for intestinal malrotation. 

Preduodenal portal vein (PPV) is a rare congenital anomaly associated with additional various anomalies, including intestinal malrotation, situs anomalies, IVC anomalies, polysplenia, pancreatic anomalies, duodenal atresia, and cardiac anomalies (Tsuda et al. 1991 Gayer et al. 1999). On CT, the preduodenal and prepancreatic localization of the portal vein is demonstrated, as well as any associated anomalies (Fig. 9.5). The diagnosis of a PPV before surgical intervention in the upper abdomen is important to prevent its inadvertent ligation or transection (Tsuda et al. 1991). 

Pickhardt PJ, Bhalla S (2002) Intestinal malrotation in adolescents and adults spectrum of clinical and imaging features. Am J Roentgenol 179 1429-1435... 

Zissin R, Rathaus V, Oscadchy A et al (1999) Intestinal malrotation as an incidental finding on CT in adults. Abdom Imaging 24 550-555... 

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