Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases.
OBJECTIVE
To analyze difficult diagnostic cases of malrotation to identify features crucial to accurate diagnosis.


METHODS
The authors reviewed the radiographs and records of 81 symptomatic children who underwent surgery with a preoperative diagnosis of malrotation. Eleven had subtle rotational abnormalities (potential false-negative examinations), and 12 had false-positive upper gastrointestinal examinations.


RESULTS
Subtle signs of malrotation included unusual redundancy of the duodenum to the right of the spine and location of the duodenojejunal junction (DJJ) medial to the left pedicle. Nevertheless, two children with variations of malrotation had normal upper gastrointestinal examinations. False-positive diagnoses resulted from failure to recognize normal variants: jejunum in the right upper quadrant as the sole finding, DJJ over the left pedicle on the anteroposterior view, "duodenum inversum," and "duodenum mobile." Three children had bowel distention that displaced the DJJ.


CONCLUSIONS
Diagnosis of difficult cases of malrotation may depend on recognition of anatomic subtleties. False-positive diagnoses may be avoided by appreciation of normal duodenal variants.
Long
F R
FR
Department of Radiology, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Kramer
S S
SS
Markowitz
R I
RI
Taylor
G E
GE
Liacouras
C A
CA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011859:Radiography; D012189:Retrospective Studies