Which two anatomic features of malrotation lead to clinical symptoms?
1. Narrow mesenteric base permits abnormal mobility of the small bowel, allowing the mesentery to twist around the superior mesenteric artery. The resulting volvulus can therefore cause ischemia of the small bowel. 2. Ladd bands, which cross the duodenum, can lead to obstruction.
What is the sensitivity of upper GI series with signs of malrotation?
Approximately 96 percent. Findings include a clearly misplaced duodenum (ie, ligament of Treitz on the right side of the abdomen) that has a "corkscrew" appearance and duodenal obstruction, which can have a "beak" appearance.
Should CT of the abdomen be the initial diagnostic test for malrotation in infants, children and adolescents?
No. CT of the abdomen should not be the initial diagnostic test because of the potential radiation exposure when compared to an upper gastrointestinal (GI) contrast series. However, in adults, abdominal CT is favored.
Contrast CT scan of the abdomen showed malrotation of the small intestine with the jejunum and a large part of the ileum placed on the right side of the abdomen with dilated, fluid-filled ileum loops. In addition, signs of low signal in the mesentery gave suspicion of peritonitis and free intraabdominal fluid. Small air bubbles were seen in the right hypochondrium. There were visualized dilated loops of ileum up to the ileocecal junction with “fecal sign”. Based on the diagnosis of malrotation, the patient consented for exploratory laparoscopy with the possibility of conversion to laparotomy.