Sonographic assessment of the retroperitoneal position of the third portion of the duodenum: an indicator of normal intestinal rotation.
BACKGROUND
The diagnosis of intestinal malrotation is based on an upper gastrointestinal contrast series (UGI), which is considered the imaging reference standard. It may however be challenging even for experienced paediatric radiologists.


OBJECTIVE
The purpose of this study was to demonstrate the agreement between UGI and US in assessing the position of the third portion of the duodenum (D3) and to show that a retroperitoneal duodenum indicates normal forgut rotation.


METHODS
In a prospective study, US assessment of the duodenum and the superior mesenteric vessels was performed in consecutive children who were referred for clinically indicated UGI at a single institution.


RESULTS
Eighty-five children, 5 months to 14 years old, were studied. In 82/85 (96%), both US and UGI suggested normal forgut rotation. In three children, US demonstrated a normal position of the D3 whereas UGI showed an abnormal position of the duodeno-jejunal junction.


CONCLUSIONS
US is a non-invasive, easily performed technique for excluding malrotation. UGI may be reserved for situations where US does not demonstrate a normal position of the D3.
Paediatric Radiology Unit, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium. renaud.menten@rdgn.ucl.ac.be
Renaud
R
Menten
Raymond
R
Reding
Véronique
V
Godding
Dana
D
Dumitriu
Philippe
P
Clapuyt
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004065:Digestive System Abnormalities / Q000000981:diagnostic imaging; D004386:Duodenum / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008643:Mesentery / Q000098:blood supply; D011446:Prospective Studies; D012016:Reference Values; D012399:Rotation; D014463:Ultrasonography
D003287:Contrast Media