Beverley Newman1, Raji Koppolu, Daniel Murphy, Karl Sylvester. 1. Department of Radiology, Stanford University, Lucile Packard Children's Hospital, 725 Welch Road, MC 5913, Stanford, CA, 94305, USA, bevn@stanford.edu.
Abstract
BACKGROUND: Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. OBJECTIVE: To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. MATERIALS AND METHODS: Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. RESULTS: Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. CONCLUSION: We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates.
BACKGROUND:Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. OBJECTIVE: To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. MATERIALS AND METHODS: Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. RESULTS: Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. CONCLUSION: We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates.
Authors: Charissa R Pockett; Bryan Dicken; Ivan M Rebeyka; David B Ross; Lindsay M Ryerson Journal: Pediatr Cardiol Date: 2012-05-29 Impact factor: 1.655
Authors: Stephanie Papillon; Catherine J Goodhue; Osnat Zmora; Shalini S Sharma; Winfield J Wells; Henri R Ford; Jeffrey S Upperman; Kasper S Wang; Gerald A Bushman; Richard Kim; James R Pierce Journal: J Pediatr Surg Date: 2013-01 Impact factor: 2.545
Authors: David C Yu; Ravi R Thiagarajan; Peter C Laussen; James P Laussen; Tom Jaksic; Christopher B Weldon Journal: J Pediatr Surg Date: 2009-06 Impact factor: 2.545
Authors: Catherine C Pickin; James Castle; Vibha Shaji; Adeolu Banjoko; Aimee-Louise Chambault; Anna N Seale; Anthony Lander; Chetan Mehta; Adrian Crucean Journal: J Cardiovasc Dev Dis Date: 2021-03-28