Ultrasound as a feasible method for the assessment of malrotation

BACKGROUND: In malrotation the position of third portion of duodenum (D(3)) is always intramesenteric. Demonstration of normal retromesenteric-retroperitoneal position of D(3) on ultrasound (US) can rule out malrotation. The aim of this study was to evaluate the feasibility of US in demonstrating the retroperitoneal D(3). MATERIAL/METHODS: Abdominal US study was done for various indications in 60 newborns and infants (mean age: 33 days [range: 4–100 days]; 56.7% male) by an expert pediatric radiologist. The position of D(3) and its adjacent structures was evaluated in axial and longitudinal planes by linear and curved transducers. RESULTS: A normal retromesenteric-retroperitoneal D(3) located between the superior mesenteric artery and the aorta was seen on US in all patients, including those with extensive gas in the bowel. The mean time of D(3) observation was 47.8 s (10–180 s). Ultrasound was also capable of demonstrating D(3) structure, diameter, content, adjacent structures, relative position of the superior mesenteric artery and vein. CONCLUSIONS: Ultrasound is a simple, fast and highly accurate tool to confirm the retroperitoneal position of D(3). Ultrasound can be used as a screening method for malrotation eliminating the need for unnecessary barium studies.