Abstract
To make an inventory of the radiological findings involved in midget malrotation 62 consecutive patients with surgically proven isolated malrotation of the midget were evaluated. Findings at plain abdominal radiography, upper gastrointestinal series. barium enema, ultrasound and/or CT were reviewed, correlated with the findings at surgery and classified into clinical entities related to embryological development. Findings were normal in 21 of 47 plain abdominal radiographs, 3 of 49 upper gastrointestinal series, 10 of 49 barium enemas and 9 of 14 ultrasound and/or CT examinations. All other examinations showed a multitude of abnormalities. Complete radiological classification into the clinical entities was possible in 39 patients (62.9 %). Partial classification could be established in the remaining 23 patients (37.1 %). It is concluded that midget malrotation is a treacherous disease with a multitude of appearance.
By using the classification described, interpretation of findings becomes easier.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Berardi RS (1980) Anomalies of midgut rotation in the adult. Surg Gynecol Obstet 151: 113–124
Stewart DR, Colodny AL, Daggett WC (1976) Malrotation of the bowel in infants and children: a 15 year review. Surgery 79: 716–720
Griska LB, Popky GL (1980) Angiography in midgut malrotation with volvulus. AJR 134: 1055–1056
Brandt ML, Pokorny WJ, McGill CW, Harberg FJ (1985) Late presentations of midgut malrotation in children. Am J Surg 150: 767–771
Rescorla FJ, Shedd FJ, Grosfeld JL, Vane DW, West KW (1990) Anomalies of intestinal rotation in childhood: analysis of 447 cases. Surgery 108: 710–716
Kiesewetter WB, Smith JW (1958) Malrotation of the midgut in infancy and childhood. Arch Surg 77: 483–491
Filston HC, Kirks DR (1981) Malrotation: The ubiquitous anomaly. J Pediatr Surg 16: 614–620
Berdon WE, Baker DH, Bull S, Santulli TV (1970) Midgut malrotation and volvulus which films are most helpful? Radiology 96: 375–383
Gaines PA, Saunders AJS, Drake D (1987) Midgut malrotation diagnosed by ultrasound. Clin Radiol 38: 51–53
Festen C, Hendriks JHC (1976) Malrotatie: symptomen en diagnostiek. Ned Tijdschr Geneesk 120: 2225–2231
El-Gohari MA, Cook RCM (1984) Intestinal malrotation beyond the neonatal period. Z Kinderchir 39: 237–241
Simpson AJ, Leonidas JC, Krasna IH, Becker JM, Schneider KM (1972) Roentgendiagnosis of midgut malrotation: value of upper gastrointestinal radiographic study. J Pediatr Surg 7: 243–252
Geoffray A, Montagne JP, Gruner M, Fauré C (1984) Apport de la radiologie au diagnostic des volvulus par anomalie de rotation mésentérique. Arch Fr Pediatr 41: 249–253
Yanez R, Spitz L (1986) Intestinal malrotation presenting outside the neonatal period. Arch Dis Child 61: 682–685
Jackson A, Bisset R, Dickson AP (1989) Case report: malrotation and midgut volvulus presenting as malabsorption. Clin Radiol 40: 536
Wang CA, Welch CE (1963) Anomalies of intestinal rotation in adolescents and adults. Surgery 54: 839–855
Balthazar EJ (1977) Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. I. Abnormalities of rotation. Gastrointest Radiol 2: 41–47
Nichols DM, Li DK (1983) Superior mesenteric vein rotation: a CT-sign of midgut malrotation. AJR 141: 707–708
Bill AH (1979) Malrotation of the intestine. In: Ravitch MM, Welch KJ, Benson CD, et al (eds) Pediatric surgery. Year Book Medical, Chicago, pp 912–923
Balthazar EJ (1976) Intestinal malrotation in adults: roentgenographic assessment with emphasis on isolated complete and partial nonrotations. AJR 126: 358–367
Cremin BJ, Cywers S, Louw JH (1973) Rotational anomalies. In: Radiological diagnosis of digestive tract disorders in the newborn. Butterworth, London, pp 68–76
Langman J (1976) Middendarm. In: Inleiding tot de embryologic. 8e herziene druk. Bohn, Scheltema & Holkema, Utrecht, pp 277–283
Snyder WH, Chaffin L (1954) Embryology and pathology of the intestinal tract: presentation of 40 cases of malrotation. Ann Surg 140: 368–379
Balthazar EJ (1977) Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. II. Abnormalities of fixation. Gastrointest Radiol 2: 49–56
Caffey J (1978) Duodenum. In: Pediatric X-ray diagnosis, 7th edn. Year Book Medical Chicago, pp 1719–1726
Buranasiri SI, Baum S, Nusbaum M, Tumen H (1973) The angiographic diagnosis of midgut malrotation with volvulus in adults. Radiology 109: 555–556
Frye TR, Mah CL, Schiller M (1972) Roentgenographic evidence of gangrenous bowel in midgut volvulus with observations in experimental volvulus. AJR 114: 394–401
Potts SR, Thomas PS, Garstin WIH, McGoldrick J (1985) The duodenal triangle: a plain film sign of midgut malrotation and volvulus in the neonate. Clin Radiol 36: 47–49
de Bruyn R, Hall CM, Spitz L (1982) Hirschsprung's disease and malrotation of the midgut: an uncommon association. Br J Radiol 55: 554–557
De Prima SJ, Hardy DC, Brant WE (1985) Reversed intestinal rotation. Radiology 157: 603–604
Taylor GA, Littlewood Teel R (1985) Chronic intestinal obstruction mimicking malrotation in children. Pediatr Radiol 15: 392–394
Berger RB, Hillemeier AC, Stahl RS, Markowitz RA (1982) Volvulus of the ascending colon: an unusual complication of non-rotation of the midgut. Pediatr Radiol 12: 298–300
Konings-Beetstra EI, van der Jagt ES (1990) Malrotation of the midgut: a rare complication in an adult patient. Eur J Radiol 11: 73–77
Katz ME, Siegel MJ, Shackelford GD, McAlister WH (1987) The position and mobility of the duodenum in children. AJR 148: 947–951
Meyers MA, Volberg F, Katzen B, Abbott G (1973) Haustral anatomy and pathology: a new look. Radiology 108: 497–504
Whalen JP (1975) Anatomy of the colon: guide to intra-abdominal pathology. AJR 125: 3–20
Whalen JP, Riemenschneider PA (1967) An analysis of the normal anatomic relationship of the colon as applied to roentgenographic observations. AJR 99: 55–61
Borghol M, Holdsworth J (1987) Reversed rotation of the midgut in an adult: case report. Acta Chir Scand 153: 395–397
Mori H, Hayashi K, Futagawa S, Uetani M, Yanagi T, Kurosaki N (1987) Vascular compromise in chronic volvulus with midgut malrotation. Pediatr Radiol 17: 277–281
Loyer E, Dunne Egli K (1989) Sonographic evaluation of superior mesenteric vascular relationship in malrotation. Pediatr Radiol 19: 173–175
Carrington BM, Martin DF (1987) Position of the superior mesenteric artery on computed tomography and its relationship to retroperitoneal disease. Br J Radiol 60: 997–999
Zerin JM, DiPietro MA (1991) Mesenteric vascular anatomy at CT: normal and abnormal appearances. Radiology 179: 739–742
Hayden CK, Boulden TF, Swischuk LE, Lobe TE (1984) Sonographic demonstration of duodenal obstruction with midgut volvulus. AJR 143: 9–10
Dufour D, Delaet MH, Dassonville M, Cadranel S, Perlmutter N (1992) Midgut malrotation: the reliability of sonographic diagnosis. Pediatr Radiol 22: 21–23
Paul AB, Dean DM (1990) Computed tomography in volvulus of the midgut. Br J Radiol 63: 893–894
Izes BA, Scholz FJ, Munson JL (1992) Midgut volvulus in an elderly patient. Gastrointest Radiol 17: 102–104
Shatzkes D, Gordon DH, Haller JO, Kantor A, De Silva R (1990) Malrotation of the bowel: malalignment of the superior mesenteric artery-vein complex shown by CT and MR. J Comput Assist Tomogr 14: 93–95
Lieberman JM, Haaga JR (1982) Duodenal malrotation. J Comput Assist Tomogr 6: 1019–1020
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
van den Berg, J.C. Midgut malrotation: radiological features of a twist of nature. Eur. Radiol. 4, 231–237 (1994). https://doi.org/10.1007/BF00606453
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00606453