Bindey Kumar1, Manish Kumar2, Prem Kumar3, Amit Kumar Sinha1, Utpal Anand4, Anil Kumar5. 1. Department of Pediatric Surgery, All India Institute of Medical Sciences, Phulwari Sharif, Patna, 801 507, India. 2. Department of Pediatrics, All India Institute of Medical Sciences, Phulwari Sharif, Patna, 801 507, India. singh.manish.15@gmail.com. 3. Department of Radiology, All India Institute of Medical Sciences, Phulwari Sharif, Patna, 801 507, India. 4. Department of Gastrosurgery, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, 800 014, India. 5. Department of Surgery, All India Institute of Medical Sciences, Phulwari Sharif, Patna, 801 507, India.
Abstract
BACKGROUND: Malrotation with midgut volvulus is a common surgical emergency in children. A diagnostic tool for malrotation with characteristics ideal in emergency settings such as non-invasiveness and rapidity remains a keenly debated issue among surgeons and radiologists alike. METHODS: Fifty-two pediatric patients of suspected malrotation with midgut volvulus were studied between 1998 and 2016. All patients underwent plain abdominal X-ray and Color Doppler; contrast upper gastrointestinal (GI) studywas done in some patients. All cases were operated and diagnosis was confirmed. A subset of 60 pediatric patients with nonspecific GI complaints were also examined to see relative position of superior mesenteric vein (SMV)/superior mesenteric artery (SMA) in control population. RESULT: A total of 52 suspected cases of malrotation were admitted from May 1998 to November 2015, 43 had inversion of SMA/SMV and nine had SMV anterior of SMA in Color Doppler. All 43 cases of inversion of SMA/SMV were cases of malrotation after surgical confirmation; while five out of nine cases of SMV anterior to SMA had malrotation. CONCLUSION: In appropriate clinical settings, Color Doppler documenting the reversal or aberrant SMV/SMA axis is not only predictive but also diagnostic of malrotation of gut.
BACKGROUND: Malrotation with midgut volvulus is a common surgical emergency in children. A diagnostic tool for malrotation with characteristics ideal in emergency settings such as non-invasiveness and rapidity remains a keenly debated issue among surgeons and radiologists alike. METHODS: Fifty-two pediatric patients of suspected malrotation with midgut volvulus were studied between 1998 and 2016. All patients underwent plain abdominal X-ray and Color Doppler; contrast upper gastrointestinal (GI) studywas done in some patients. All cases were operated and diagnosis was confirmed. A subset of 60 pediatric patients with nonspecific GI complaints were also examined to see relative position of superior mesenteric vein (SMV)/superior mesenteric artery (SMA) in control population. RESULT: A total of 52 suspected cases of malrotation were admitted from May 1998 to November 2015, 43 had inversion of SMA/SMV and nine had SMV anterior of SMA in Color Doppler. All 43 cases of inversion of SMA/SMV were cases of malrotation after surgical confirmation; while five out of nine cases of SMV anterior to SMA had malrotation. CONCLUSION: In appropriate clinical settings, Color Doppler documenting the reversal or aberrant SMV/SMA axis is not only predictive but also diagnostic of malrotation of gut.
Entities:
Keywords:
Mesenteric vessels; Ultrasonography; Upper GI series