How Useful is Ultrasound in the Imaging Workup of Malrotation?

Abstract

Background: The position of third portion of duodenum (D3) is always intramesenteric in malrotation. Displaying normal retromesenteric- retroperitoneal position of D3 by ultrasound (US) can help to rule out malrotation. Objectives: The aim of this study was to evaluate the feasibility of US in demonstration of retroperitoneal D3. Patients and Methods: Abdominal US study was performed for various indications in sixty newborns and infants [Mean age: 33 days (range: 4-100 days); 56.7% male] by an expert paediatric radiologist. D3 position and its adjacent structures were evaluated in axial and longitudinal planes by linear and curve transducers. Results: Normal retromesenteric-retroperitoneal D3 between superior mesenteric artery and aorta was seen by US in all patients, including those with severe bowel gas. Mean time for displaying D3 was 47.8 s (10-180 s). Ultrasound was also capable to demonstrate D3 structure, diameter, content, its adjacent structures, relative position of superior mesenteric artery and vein. Conclusions: Ultrasound is a simple, fast and highly accurate modality for confirming retroperitoneal position of D3. Ultrasound can be used as the screening method for malrotation and obviate unnecessary barium studies.