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Normal Variations of Duodenojejunal Junction Position
Steven J. Kraus, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • D1-D4: 1st through 4th duodenal segments
          • Definitions

            • Ligament of Treitz (LOT): Combination of muscle & fibrous tissue; normal position implies normal midgut rotation & fixation not at risk of midgut volvulus
              • Upper portion of LOT (Hilfsmuskel) attached to diaphragmatic crus near esophageal hiatus; skeletal muscle & fibrous tissue component attaches to celiac axis
              • Lower portion of LOT (suspensory muscle of duodenum) inserts at duodenojejunal junction (DJJ) & has fibrous connection to celiac axis
              • Function
                • Involved in process of normal bowel rotation
                • With contraction, suspensory muscle of LOT widens angle of duodenojejunal flexure, allowing movement of intestinal contents

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • Ultrasonographic Findings

                  • CT Findings

                    • MR Findings

                      DIFFERENTIAL DIAGNOSIS

                        CLINICAL ISSUES

                        • Treatment

                          Selected References

                          1. Dumitriu DI et al: Ultrasound of the duodenum in children. Pediatr Radiol. 46(9):1324-31, 2016
                          2. Tang V et al: Disorders of midgut rotation: making the correct diagnosis on UGI series in difficult cases. Pediatr Radiol. 43(9):1093-102, 2013
                          3. Nehra D et al: Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 149(3):386-93, 2011
                          4. 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
                          5. 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
                          6. Slovis TL et al: Malrotation: some answers but more questions. Pediatr Radiol. 39(4):315-6, 2009
                          7. 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
                          8. Kim SK et al: The ligament of Treitz (the suspensory ligament of the duodenum): anatomic and radiographic correlation. Abdom Imaging. 33(4):395-7, 2008
                          9. Applegate KE et al: Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 26(5):1485-500, 2006
                          10. Strouse PJ: Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 34(11):837-51, 2004
                          11. Long FR et al: Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases. Radiology. 198(3):775-80, 1996
                          12. Long FR et al: Radiographic patterns of intestinal malrotation in children. Radiographics. 16(3):547-56; discussion 556-60, 1996
                          13. Berdon WE: The diagnosis of malrotation and volvulus in the older child and adult: a trap for radiologists. Pediatr Radiol. 25(2):101-3, 1995
                          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

                                  TERMINOLOGY

                                  • Abbreviations

                                    • D1-D4: 1st through 4th duodenal segments
                                  • Definitions

                                    • Ligament of Treitz (LOT): Combination of muscle & fibrous tissue; normal position implies normal midgut rotation & fixation not at risk of midgut volvulus
                                      • Upper portion of LOT (Hilfsmuskel) attached to diaphragmatic crus near esophageal hiatus; skeletal muscle & fibrous tissue component attaches to celiac axis
                                      • Lower portion of LOT (suspensory muscle of duodenum) inserts at duodenojejunal junction (DJJ) & has fibrous connection to celiac axis
                                      • Function
                                        • Involved in process of normal bowel rotation
                                        • With contraction, suspensory muscle of LOT widens angle of duodenojejunal flexure, allowing movement of intestinal contents

                                  IMAGING

                                  • General Features

                                    • Radiographic Findings

                                      • Fluoroscopic Findings

                                        • Ultrasonographic Findings

                                          • CT Findings

                                            • MR Findings

                                              DIFFERENTIAL DIAGNOSIS

                                                CLINICAL ISSUES

                                                • Treatment

                                                  Selected References

                                                  1. Dumitriu DI et al: Ultrasound of the duodenum in children. Pediatr Radiol. 46(9):1324-31, 2016
                                                  2. Tang V et al: Disorders of midgut rotation: making the correct diagnosis on UGI series in difficult cases. Pediatr Radiol. 43(9):1093-102, 2013
                                                  3. Nehra D et al: Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 149(3):386-93, 2011
                                                  4. 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
                                                  5. 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
                                                  6. Slovis TL et al: Malrotation: some answers but more questions. Pediatr Radiol. 39(4):315-6, 2009
                                                  7. 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
                                                  8. Kim SK et al: The ligament of Treitz (the suspensory ligament of the duodenum): anatomic and radiographic correlation. Abdom Imaging. 33(4):395-7, 2008
                                                  9. Applegate KE et al: Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 26(5):1485-500, 2006
                                                  10. Strouse PJ: Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 34(11):837-51, 2004
                                                  11. Long FR et al: Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases. Radiology. 198(3):775-80, 1996
                                                  12. Long FR et al: Radiographic patterns of intestinal malrotation in children. Radiographics. 16(3):547-56; discussion 556-60, 1996
                                                  13. Berdon WE: The diagnosis of malrotation and volvulus in the older child and adult: a trap for radiologists. Pediatr Radiol. 25(2):101-3, 1995