Journal of Ultrasound in Medicine, Vol 19, Issue 6 371-376, Copyright © 2000 by American Institute of Ultrasound in Medicine
Sonographic features related to volvulus in neonatal intestinal malrotation
H. C. Chao, M. S. Kong, J. Y. Chen, S. J. Lin and J. N. Lin
Division of Gastroenterology, Chang Gung Children's Hospital, Taoyuan, Taiwan.
This 3 year prospective study evaluated the sensitivity and specificity of
abdominal ultrasonography and color Doppler ultrasonography in 31 neonates
with suspected malrotation or malrotation with volvulus. Water instillation
was used to detect duodenal dilatation, edema, and malrotated bowels.
Twenty patients with ultrasonographic characteristics of inversion of the
superior mesenteric artery and superior mesenteric vein were later
surgically proved to have malrotation. Nine of these 20 patients also had
volvulus. Sonographic features suggestive of volvulus included duodenal
dilation with tapering configuration (8 of 9 cases, 89%), fixed midline
bowel (8 of 9 cases, 89%), whirlpool sign (8 of 9 cases, 89%), and dilation
of the distal superior mesenteric vein (5 of 5 cases, 100%). The
sensitivity and specificity of duodenal dilation with tapering
configuration for detecting volvulus were 89% and 92%, respectively; of
fixed midline bowel, 89% and 92%; of whirlpool sign, 89% and 92%; and of
dilation of distal superior mesenteric vein, 56% and 73%. The results of
this study indicate that ultrasonographic features of inversion of the
superior mesenteric artery and superior mesenteric vein could aid in the
diagnosis of malrotation, and certain sonographic features can also be used
to evaluate volvulus, a condition requiring emergent operation.
