title: Antenatally diagnosed right-sided stomach (dextrogastria): A rare rotational anomaly.
abstract: OBJECTIVE
  Antenatal detection of right-sided stomach (dextrogastria) is rare, and its significance in regards to intestinal rotation is unclear. We aimed to review all cases of antenatally-diagnosed dextrogastria in our regional fetal medicine unit over 10years.
  
  
  METHODS
  A retrospective case-note review of patients identified from a prospectively-maintained database was performed.
  
  
  RESULTS
  Twenty cases of antenatally-diagnosed dextrogastria were identified from 2004 to 2014. There were 8 terminations and 1 intra-uterine death. One patient has no post-natal information obtainable. Ten infants were live-born, and 2 died secondary to cardiac disease in the neonatal period. All had significant cardiac/vascular anomaly on postnatal assessment, including the 3 neonates in whom dextrogastria was the only antenatal finding. Two neonates developed bilious vomiting and underwent Ladd's procedure. Operative findings were dextrogastria/malrotation in both. A third child had gastro-oesophageal reflux, and contrast demonstrated stable duodenal/midgut position. This child has not developed symptoms attributable to malrotation and not undergone surgery. All 3 of these infants had asplenia or polysplenia and were managed with antibiotic prophylaxis/immunisation. Five children in the series were not investigated for malrotation and have not come to surgical attention (one is known to be asplenic).
  
  
  CONCLUSIONS
  Antenatally-detected dextrogastria, even if apparently isolated, was always associated with postnatal significant cardiovascular anomaly, splenic abnormality or situs inversus. This may be important for antenatal counselling. We currently recommend postnatal echocardiography and splenic assessment, but reserve GI investigation/intervention for symptomatic malrotation owing to potential significant cardiac comorbidity.
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust.
authors.forename: Hendt P
authors.initials: HP
authors.lastname: Versteegh
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Adams
authors.affiliation: Department of Fetal Medicine,University Hospital Southampton Foundation NHS Trust.
authors.forename: Sally
authors.initials: S
authors.lastname: Boxall
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust.
authors.forename: David M
authors.initials: DM
authors.lastname: Burge
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust. Electronic address: michael.stanton@uhs.nhs.uk.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stanton
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D012857:Situs Inversus / Q000175:diagnosis*; D013270:Stomach / Q000002:abnormalities*; D013272:Stomach Diseases / Q000151:congenital / Q000175:diagnosis*; D014102:Torsion Abnormality / Q000151:congenital / Q000175:diagnosis*
keywords: Antenatal diagnosis; Dextrogastria; Intestinal rotation