Gazzi Lynn

Final Pr. ID: Poster #: EDU-006 (T)

Intestinal malrotation is a defect that occurs in the 10th week of gestation. During this stage the intestines normally migrate back into the abdominal wall following a brief period where they are temporarily located in the base of the umbilical cord. As the intestines returns to the abdomen it makes two rotations and becomes fixed into its normal position. The small bowel is located in the center of the abdomen and the large intestine drapes around the top and sides of the small intestine. When rotation is incomplete and intestinal fixation does not occur, this creates a defect known as malrotation. Malrotation occurs in one of every 500 births in the United States. Up to 40 percent of patients with this show signs of the disease within the first week of life. By one month of age 50-60 percent are diagnosed. 75 to 90 percent are diagnosed by age 1. The remaining cases are diagnosed into adulthood. Some symptoms of malrotation include vomiting and bilious emesis, fussiness, crying in pain, a swollen abdomen that’s tender to the touch, fever, diarrhea and bloody stool or none at all. If malrotation is not treated, it can lead or turn into a midgut vovulus. This is when the gut twists counterclockwise around the superior mesenteric artery and vein causing a narrowing. This may cause abdominal distention and pain or acute bowel necrosis. It can also be life threatening or lead to a lifelong dependence on total parenteral nutrition, so surgical correction is the dependent treatment. When medical history and physical examination indicate a suspicion of malrotation and vovulus, patients must undergo blood tests and diagnostic imaging studies to evaluate the position of the intestine to determine if there is blockage or twisting. The imaging modality of choice remains the upper GI study. This is a fluoroscopic study using barium contrast to look at the upper and middle sections of the gastrointestinal tract. A radiologist’s knowledge of normal anatomy is important in performing and interpreting the upper GI series. From a technical standpoint common pitfalls during this test that can lead to a misdiagnosis would be imaging quality. Improper patient positioning, nonsufficient images taken and the wrong amount of contrast administered during the most crucial part of the study can lead to false findings. The purpose of this abstract is to present case studies and imaging which mimic intestinal rotation but are a normal variant vs. actual cases of malrotation Read More

Authors:  Gazzi Lynn

Keywords:  malrotation, midgut vovulus, image findings