The performance of ultrasound and upper gastrointestinal study in diagnosing malrotation in children, with or without volvulus

Emerg Radiol. 2024 Apr;31(2):151-165. doi: 10.1007/s10140-024-02201-9. Epub 2024 Jan 30.


Background: Rapid diagnosis is crucial for pediatric patients with midgut volvulus and malrotation to prevent serious complications. While the upper gastrointestinal study (UGIS) is the traditional method, the use of ultrasound (US) is gaining prominence.

Objectives: To assess the diagnostic sensitivity and specificity of US compared to UGIS for malrotation and midgut volvulus.

Methods: A cross-sectional study was performed on 68 pediatric patients who underwent US and/or UGIS before surgery for suspected midgut volvulus or malrotation in Kuala Lumpur (PPUKM and HTA), referencing surgical outcomes as the gold standard.

Results: US demonstrated a higher specificity (100%) than UGIS (83%) for diagnosing malrotation, with a slightly lower sensitivity (97% vs. 100%). For midgut volvulus, US surpassed UGIS in sensitivity (92.9% vs. 66.7%) while maintaining comparable specificity. The SMA/SMV criteria showed better sensitivity (91.1%) than the D3 assessment (78.9%) on US, though both had high specificity.

Conclusion: US is equivalent to UGIS for identifying malrotation and is more sensitive for detecting midgut volvulus, supporting its use as a primary diagnostic tool. The study advocates for combined US and UGIS when either yields inconclusive results, optimizing diagnostic precision for these conditions.

Keywords: Malrotation; Midgut volvulus; Ultrasound; Upper gastrointestinal study.

MeSH terms

  • Child
  • Cross-Sectional Studies
  • Humans
  • Intestinal Volvulus* / diagnostic imaging
  • Intestinal Volvulus* / surgery
  • Sensitivity and Specificity
  • Ultrasonography