David K. Yousefzadeh MD, Presenter: Nothing to Disclose

Purpose Upper gastrointestinal studies (UGI) have so far examined all but the third segments of the duodenal sweep (D3) in evaluation for malrotation.We propose that only illustrating the retromesenteric position of D3 fulfills the embryologic and anatomic requirements for excluding malrotation.  

Material & Methods  Between 1996 and 2010, 17 problematic cases had both UGI and ultrasound (US) studies. Position and direction of the second and fourth portions of the duodenum (D2 &D4), the duodenojejunal junction (DJJ), and configuration of the duodenal sweep were evaluated. US images were obtained using curvilinear, sector, and linear transducers in axial and longitudinal planes. The evaluated US parameters included assessing the position of D3 and arrangement of the superior mesenteric vessels.  

Results  Female to male ratio was 9/8. Eleven were newborns. Excluding a 44 year-old man, the average age was 7.2 months. The clinical history included bilious and nonbilious vomiting, abdominal distention, and abdominal pain. UGI findings fulfilled the current criteria of malrotation in all, in whom US illustrated the retromesenteric D3 and excluded malrotation.  

Conclusion Unlike UGI, US fulfills the embryologic and anatomic requirements by demonstrating the retomesenteric D3, excluding malrotation and the potential for midgut volvulus  

Clinical Relevance US assisted exclusion of malrotation, with no radiation hazards, is based on embryological and anatomic principles with zero % false positive rates, vs. up to 15% for UGI.  

Yousefzadeh, D, The Role of Ultrasound (US) vs UGI in Excluding Malrotation in Seventeen Problematic Patients.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12033177.html