Ligament of Treitz (LOT): Combination of muscle & fibrous tissue; normal position implies normal midgut rotation & fixation, low risk of midgut volvulus
Upper portion of LOT (Hilfsmuskel) is 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
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
Dumitriu DI et al: Ultrasound of the duodenum in children. Pediatr Radiol. 46(9):1324-31, 2016
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
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
Slovis TL et al: Malrotation: some answers but more questions. Pediatr Radiol. 39(4):315-6, 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
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
Applegate KE et al: Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 26(5):1485-500, 2006
Strouse PJ: Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 34(11):837-51, 2004
Long FR et al: Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases. Radiology. 198(3):775-80, 1996
Long FR et al: Radiographic patterns of intestinal malrotation in children. Radiographics. 16(3):547-56; discussion 556-60, 1996
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-4th duodenal segments
Definitions
Ligament of Treitz (LOT): Combination of muscle & fibrous tissue; normal position implies normal midgut rotation & fixation, low risk of midgut volvulus
Upper portion of LOT (Hilfsmuskel) is 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
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
Dumitriu DI et al: Ultrasound of the duodenum in children. Pediatr Radiol. 46(9):1324-31, 2016
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
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
Slovis TL et al: Malrotation: some answers but more questions. Pediatr Radiol. 39(4):315-6, 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
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
Applegate KE et al: Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 26(5):1485-500, 2006
Strouse PJ: Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 34(11):837-51, 2004
Long FR et al: Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases. Radiology. 198(3):775-80, 1996
Long FR et al: Radiographic patterns of intestinal malrotation in children. Radiographics. 16(3):547-56; discussion 556-60, 1996
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
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