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Intestinal Malrotation in Children: A Problem-solving Approach to the Upper Gastrointestinal Series¹

¹ From the Department of Radiology, Riley Hospital for Children, 702 Barnhill Dr, Room 1053B, Indianapolis, IN 46202. Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received August 30, 2005; revision requested November 10 and received December 21; accepted April 4, 2006. All authors have no financial relationships to disclose. Address correspondence to K.E.A. (e-mail: kiappleg{at}iupui.edu).

Intestinal malrotation, which is defined by a congenital abnormal position of the duodenojejunal junction, may lead to midgut volvulus, a potentially life-threatening complication. An evaluation for malrotation is part of every upper gastrointestinal (GI) tract examination in pediatric patients, particularly neonates and infants. Although the diagnosis of malrotation is often straightforward, the imaging features in approximately 15% of upper GI tract examinations are equivocal and lead to a false-positive or false-negative interpretation. The clinical manifestations and upper GI tract findings of malrotation in older children and adults are less specific than are those in younger patients, and for this reason diagnosis of the condition may be more difficult. Successful differentiation between a normal variant and malrotation requires the use of optimal techniques in acquiring and interpreting the upper GI series. Familiarity with the upper GI series appearance of both normal and abnormal anatomic variants allows the radiologist to increase both diagnostic accuracy and confidence in the diagnosis of malrotation.

© RSNA, 2006

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