title: Contrast meals and malrotation in children-metal markers for improved accuracy.
abstract: Upper gastrointestinal contrast studies in children may cause false-positive or -negative diagnosis of intestinal malrotation from rotation of the patient. To alleviate this problem, skin markers can be used to reduce rotation of children undergoing this procedure, e.g., two metal markers (sheathed and sealed hypodermic needles) can be fixed onto the skin for gastro-intestinal contrast studies. We reviewed two Katz criteria influenced by patient rotation: duodenojejunal junction on or to the right of the left pedicle and pylorus to the left of the midline. A test group was positioned using markers; a control group without markers was positioned conventionally. Markers during a pilot study were applied, but positioning was done by helpers who had no on-screen visualization. In the test group, only 1 child (3%; n = 39) had a feature of malrotation. In the control group, there were features of malrotation in 12 children (25%; n = 48). No other features of malrotation were seen. The pilot study showed radiographic rotation with markers projecting off the midline in 78% of 58 children. This resulted in 48% of 58 patients having false features of malrotation. The use of metal skin markers results in reduction of rotational errors that could have caused false diagnosis of intestinal malrotation in children.
authors.affiliation: Deparment of Diagnostic Radiology, Faculty of Health Sciences, University of Stellenbosch, Fransie van Zyl Drive, Cape Town, South Africa.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Dekker
authors.forename: Savvas
authors.initials: S
authors.lastname: Andronikou
authors.forename: Jaco
authors.initials: J
authors.lastname: Greyling
authors.forename: Brand
authors.initials: B
authors.lastname: Louw
authors.forename: Andrew
authors.initials: A
authors.lastname: Brandt
mesh_terms: D001466:Barium Sulfate; D002648:Child; D003287:Contrast Media; D004386:Duodenum / Q000000981:diagnostic imaging*; D057918:Fiducial Markers; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis*; D007583:Jejunum / Q000000981:diagnostic imaging*; D056888:Patient Positioning; D010865:Pilot Projects; D011859:Radiography
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate