Ligament of Treitz: Suspends duodenojejunal junction (DJJ), defines normal duodenal rotation
Malrotation: Abnormal rotation & fixation of small bowel (SB) mesentery that can lead to complications, including
Midgut volvulus (MGV): Abnormal twisting of SB about superior mesenteric artery (SMA) that can lead to bowel obstruction & ischemia/necrosis
Ladd bands: Abnormal, fibrous peritoneal bands that can also cause duodenal obstruction
Bilious vomiting: Green/yellow vomit, typically from obstruction of duodenum distal to ampulla of Vater
IMAGING
General Features
Radiographic Findings
Fluoroscopic Findings
Ultrasonographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Nguyen HN et al: Transition to ultrasound as the first-line imaging modality for midgut volvulus: keys to a successful roll-out. Pediatr Radiol. 51(4):506-15, 2021
Nguyen HN et al: Untwisting the complexity of midgut malrotation and volvulus ultrasound. Pediatr Radiol. 51(4):658-68, 2021
Strouse PJ: Ultrasound for malrotation and volvulus: has the time come? Pediatr Radiol. 51(4):503-5, 2021
Expert Panel on Pediatric Imaging. et al: ACR Appropriateness Criteria® vomiting in infants. J Am Coll Radiol. 17(11S):S505-15, 2020
Hosokawa T et al: Use of ultrasound findings to predict bowel ischemic changes in pediatric patients with intestinal volvulus. J Ultrasound Med. 39(4):683-92, 2020
Nguyen HN et al: Time-driven activity-based cost comparison of three imaging pathways for suspected midgut volvulus in children. J Am Coll Radiol. 17(12):1563-70, 2020
Bartholmot C et al: Prenatal diagnosis of antenatal midgut volvulus: specific ultrasound features. Prenat Diagn. 39(1):16-25, 2019
Garcia AM et al: A multi-institutional case series with review of point-of-care ultrasound to diagnose malrotation and midgut volvulus in the pediatric emergency department. Pediatr Emerg Care. 35(6):443-7, 2019
Carroll AG et al: Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol. 23(5):559-68, 2016
Drewett M et al: The burden of excluding malrotation in term neonates with bile stained vomiting. Pediatr Surg Int. 32(5):483-6, 2016
Dumitriu DI et al: Ultrasound of the duodenum in children. Pediatr Radiol. 46(9):1324-31, 2016
Horsch S et al: Volvulus in term and preterm infants - clinical presentation and outcome. Acta Paediatr. 105(6):623-7, 2016
Shrimal PK et al: Midgut volvulus with whirlpool sign. Clin Gastroenterol Hepatol. 14(2):e13, 2016
Abdelhafeez AH et al: The risk of volvulus in abdominal wall defects. J Pediatr Surg. 50(4):570-2, 2015
Coe TM et al: Small bowel volvulus in the adult populace of the United States: results from a population-based study. Am J Surg. 210(2):201-10.e2, 2015
Kargl S et al: Volvulus without malposition--a single-center experience. J Surg Res. 193(1):295-9, 2015
Koong JK et al: Midgut volvulus: a rare cause of intestinal obstruction in adults. ANZ J Surg. 88(4):E348-9, 2015
Mitsunaga T et al: Risk factors for intestinal obstruction after Ladd procedure. Pediatr Rep. 7(2):5795, 2015
Nakagawa T et al: A case of fetal intestinal volvulus without malrotation causing severe anemia. Jpn Clin Med. 6:1-3, 2015
Raske ME et al: ACR Appropriateness Criteria Vomiting in Infants up to 3 Months of Age. J Am Coll Radiol. 12(9):915-22, 2015
Shah MR et al: Volvulus of the entire small bowel w1th normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol. 45(13):1953-6, 2015
Marine MB et al: Imaging of malrotation in the neonate. Semin Ultrasound CT MR. 35(6):555-70, 2014
Nehra D et al: Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 149(3):386-93, 2011
Taylor GA: CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation. Pediatr Radiol. 41(11):1378-83, 2011
Lampl B et al: Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol. 39(4):359-66, 2009
Yousefzadeh DK: The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation. Pediatr Radiol. 39 Suppl 2:S172-7, 2009
Patino MO et al: Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med. 23(3):397-401, 2004
Strouse PJ: Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 34(11):837-51, 2004
Chao HC et al: Sonographic features related to volvulus in neonatal intestinal malrotation. J Ultrasound Med. 19(6):371-6, 2000
Long FR et al: Radiographic patterns of intestinal malrotation in children. Radiographics. 16(3):547-56; discussion 556-60, 1996
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Ligament of Treitz: Suspends duodenojejunal junction (DJJ), defines normal duodenal rotation
Malrotation: Abnormal rotation & fixation of small bowel (SB) mesentery that can lead to complications, including
Midgut volvulus (MGV): Abnormal twisting of SB about superior mesenteric artery (SMA) that can lead to bowel obstruction & ischemia/necrosis
Ladd bands: Abnormal, fibrous peritoneal bands that can also cause duodenal obstruction
Bilious vomiting: Green/yellow vomit, typically from obstruction of duodenum distal to ampulla of Vater
IMAGING
General Features
Radiographic Findings
Fluoroscopic Findings
Ultrasonographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Nguyen HN et al: Transition to ultrasound as the first-line imaging modality for midgut volvulus: keys to a successful roll-out. Pediatr Radiol. 51(4):506-15, 2021
Nguyen HN et al: Untwisting the complexity of midgut malrotation and volvulus ultrasound. Pediatr Radiol. 51(4):658-68, 2021
Strouse PJ: Ultrasound for malrotation and volvulus: has the time come? Pediatr Radiol. 51(4):503-5, 2021
Expert Panel on Pediatric Imaging. et al: ACR Appropriateness Criteria® vomiting in infants. J Am Coll Radiol. 17(11S):S505-15, 2020
Hosokawa T et al: Use of ultrasound findings to predict bowel ischemic changes in pediatric patients with intestinal volvulus. J Ultrasound Med. 39(4):683-92, 2020
Nguyen HN et al: Time-driven activity-based cost comparison of three imaging pathways for suspected midgut volvulus in children. J Am Coll Radiol. 17(12):1563-70, 2020
Bartholmot C et al: Prenatal diagnosis of antenatal midgut volvulus: specific ultrasound features. Prenat Diagn. 39(1):16-25, 2019
Garcia AM et al: A multi-institutional case series with review of point-of-care ultrasound to diagnose malrotation and midgut volvulus in the pediatric emergency department. Pediatr Emerg Care. 35(6):443-7, 2019
Carroll AG et al: Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol. 23(5):559-68, 2016
Drewett M et al: The burden of excluding malrotation in term neonates with bile stained vomiting. Pediatr Surg Int. 32(5):483-6, 2016
Dumitriu DI et al: Ultrasound of the duodenum in children. Pediatr Radiol. 46(9):1324-31, 2016
Horsch S et al: Volvulus in term and preterm infants - clinical presentation and outcome. Acta Paediatr. 105(6):623-7, 2016
Shrimal PK et al: Midgut volvulus with whirlpool sign. Clin Gastroenterol Hepatol. 14(2):e13, 2016
Abdelhafeez AH et al: The risk of volvulus in abdominal wall defects. J Pediatr Surg. 50(4):570-2, 2015
Coe TM et al: Small bowel volvulus in the adult populace of the United States: results from a population-based study. Am J Surg. 210(2):201-10.e2, 2015
Kargl S et al: Volvulus without malposition--a single-center experience. J Surg Res. 193(1):295-9, 2015
Koong JK et al: Midgut volvulus: a rare cause of intestinal obstruction in adults. ANZ J Surg. 88(4):E348-9, 2015
Mitsunaga T et al: Risk factors for intestinal obstruction after Ladd procedure. Pediatr Rep. 7(2):5795, 2015
Nakagawa T et al: A case of fetal intestinal volvulus without malrotation causing severe anemia. Jpn Clin Med. 6:1-3, 2015
Raske ME et al: ACR Appropriateness Criteria Vomiting in Infants up to 3 Months of Age. J Am Coll Radiol. 12(9):915-22, 2015
Shah MR et al: Volvulus of the entire small bowel w1th normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol. 45(13):1953-6, 2015
Marine MB et al: Imaging of malrotation in the neonate. Semin Ultrasound CT MR. 35(6):555-70, 2014
Nehra D et al: Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 149(3):386-93, 2011
Taylor GA: CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation. Pediatr Radiol. 41(11):1378-83, 2011
Lampl B et al: Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol. 39(4):359-66, 2009
Yousefzadeh DK: The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation. Pediatr Radiol. 39 Suppl 2:S172-7, 2009
Patino MO et al: Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med. 23(3):397-401, 2004
Strouse PJ: Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 34(11):837-51, 2004
Chao HC et al: Sonographic features related to volvulus in neonatal intestinal malrotation. J Ultrasound Med. 19(6):371-6, 2000
Long FR et al: Radiographic patterns of intestinal malrotation in children. Radiographics. 16(3):547-56; discussion 556-60, 1996
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