Nguyen Haithuy,  Guillerman R,  Orth Robert,  Seghers Victor,  Bales Brandy,  Sammer Marla

Final Pr. ID: Paper #: 126

Rapid detection and accurate diagnosis of midgut volvulus are crucial due to the risk of bowel infarction with delayed diagnosis. The purpose of our study is to evaluate the diagnostic accuracy of abdominal ultrasound (US) for midgut volvulus in the clinical setting of multiple sonographers and radiologists. Read More

Authors:  Nguyen Haithuy , Guillerman R , Orth Robert , Seghers Victor , Bales Brandy , Sammer Marla

Keywords:  Midgut volvulus, Malrotation, bowel

Karmazyn Boaz,  Marine Megan,  Wanner Matthew,  Billmire Deborah

Final Pr. ID: Poster #: EDU-020

Intestinal rotation abnormality (IRA) can lead to catastrophic events from midgut volvulus. In a child that presents with bilious vomiting, urgent surgery should be performed. Ladd’s surgery is associated with complications in 10% to 20% of the patients. In this review we will show that in selected asymptomatic children with IRA, imaging can help decide if observation should be considered rather than surgery. Read More

Authors:  Karmazyn Boaz , Marine Megan , Wanner Matthew , Billmire Deborah

Keywords:  Malrotation, Nonrotation, Atypical malrotation

Lambert Elena,  Andronikou Savvas

Final Pr. ID: Poster #: EDU-036

Background:
Malrotation is an important diagnosis that needs to be identified on routine imaging and in the emergency setting. In our institution it is always surgically corrected and therefore accurate diagnosis is essential. Current teaching, supported by research, states that a lateral view on an upper gastrointestinal contrast study (UGIS) can satisfactorily demonstrate normal anatomy and a diagnosis of malrotation. The diagnosis must be made with confidence in this position because any delay in turning the patient into the AP plane can result in contrast progressing into the jejunum with overlapping bowel loops compromising the diagnosis.
Read More

Authors:  Lambert Elena , Andronikou Savvas

Keywords:  Malrotation, Midgut volvulus

Aboughalia Hassan,  Oztek Murat Alp,  Noda Sakura

Final Pr. ID: Poster #: EDU-008

A whirlpool describes rotating water created by opposing currents or upon an encounter with an obstacle. On imaging, it refers to a twist of the vascular pedicle of an organ, with a subsequent characteristic appearance on color Doppler images. Multiple abdominal pediatric emergencies are associated with a whirlpool sign, including midgut and other intestinal volvulus, testicular torsion, and ovarian torsion. This exhibit aims to review the underlying embryologic mechanism predisposing to this characteristic appearance, the role of this sign in the diagnosis of these conditions, the supporting imaging features that can help further define the diagnosis, as well as some pitfalls and differential diagnoses that can lead to a fallacious diagnosis. Read More

Authors:  Aboughalia Hassan , Oztek Murat Alp , Noda Sakura

Keywords:  Whirlpool sign, Midgut malrotation, Testicular torsion

Fagen Kimberly,  Blask Anna,  Rubio Eva,  Loomis Judyta,  Bulas Dorothy

Final Pr. ID: Poster #: SCI-008

To assess if malrotation of the bowel can be detected on prenatal MRI. Read More

Authors:  Fagen Kimberly , Blask Anna , Rubio Eva , Loomis Judyta , Bulas Dorothy

Keywords:  Malrotation, Heterotaxy, Fetal MRI

Youssfi Mostafa,  Biyyam Deepa,  Bailey Smita

Final Pr. ID: Poster #: SCI-017

To share these uncommon but important cases of Midgut Volvulus (MGV) without malrotation. Read More

Authors:  Youssfi Mostafa , Biyyam Deepa , Bailey Smita

Keywords:  VOLVULUS, MALROTATION, SMA CUT-OFF

Smitthimedhin Anilawan,  Suarez Angela,  Webb Ryan,  Otero Hansel

Final Pr. ID: Poster #: EDU-029

The diagnosis of malrotation is heavily reliant on imaging. Upper GI series remain the gold standard with the normal position of the duodenojejunal junction lateral to the left-sided pedicles of the vertebral body, at the level of the duodenal bulb on frontal views and posterior (retroperitoneal) on lateral views. However, a variety of conditions might influence the position of the duodenojejunal junction, potentially leading to a misdiagnosis of malrotation. Such conditions include gastric over distension, splenomegaly, renal or retroperitoneal tumors, liver transplant, small bowel obstruction, the presence of properly or malpositioned enteric tubes and scoliosis. All of these may cause the duodenojejunal junction to be displaced. We present a series of cases highlighting conditions that mimic malrotation to increase the practicing radiologist awareness and help minimize interpretation errors. Read More

Authors:  Smitthimedhin Anilawan , Suarez Angela , Webb Ryan , Otero Hansel

Keywords:  malrotation, Upper GI study, mimickers

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

Maria Anthony Rayer Dhilip Andrew,  Snyder Elizabeth,  Singh Sudha,  Johnstone Lindsey,  Sarma Asha,  Krishnasarma Rekha

Final Pr. ID: Poster #: EDU-015

Megacystis microcolon hypoperistalsis syndrome (MMIHS) also known as Berdon syndrome is a rare genetic disorder with a poor prognosis characterized by hypoperistalsis of the bladder and bowel. When expediently diagnosed and managed, survival can be extended. The radiologist plays a role in the initial diagnosis and recommending further imaging based on the known constellation of findings in collaboration with the pediatric surgeon and pediatric urologist. The radiologist could be the first to appreciate characteristic findings and suggest the possibility of this syndrome.

The purpose of this educational exhibit is to describe the imaging characteristics of Berdon syndrome from the fetal stage to early childhood with an emphasis on 1) main radiologic findings, 2) helpful imaging features to differentiate Berdon syndrome from other similar conditions, 3) appropriate imaging studies to assist in supporting the diagnosis, and 4) clinical findings, management, and outcome. We will review 9 cases and their corresponding imaging.

Sources:

Wymer KM, Anderson BB, Wilkens AA, Gundeti MS. Megacystis microcolon intestinal hypoperistalsis syndrome: Case series and updated review of the literature with an emphasis on urologic management. J Pediatr Surg. 2016;51(9):1565-1573.

Puri P, Shinkai M. Megacystis microcolon intestinal hypoperistalsis syndrome. Seminars in Pediatric Surgery. 2005;14(1):58-63.

Rolle U, O’Briain S, Pearl RH, Puri P. Megacystis-microcolon-intestinal hypoperistalsis syndrome: evidence of intestinal myopathy. Pediatr Surg Int. 2002;18(1):2-5. Read More

Authors:  Maria Anthony Rayer Dhilip Andrew , Snyder Elizabeth , Singh Sudha , Johnstone Lindsey , Sarma Asha , Krishnasarma Rekha

Keywords:  Berdon, intestinal hypoperistalsis, malrotation