Intestinal malrotation in newborns and infants: comparative possibilities of ultrasound and radiologic methods of investigation

BACKGROUND: Intestinal malrotation is a congenital pathology that results from abnormal fixation and rotation of the midgut during fetal development. This pathological condition is most often diagnosed during the first month of life and is often manifested by the presence of regurgitation, restlessness, vomiting with an admixture of bile, low weight gain. The narrow root of the mesentery facilitates the formation of midgut ingestion, which can lead to ischemia and necrosis and requires urgent surgical intervention. Ultrasound and radiologic examination with contrast are currently used to diagnose malrotation.

AIM: To improve the diagnosis of intestinal malrotation in newborns and infants by carrying out a comparative analysis of the capabilities of radiologic and ultrasound methods of investigation when they are used in combination.

MATERIALS AND METHODS: Data from 112 patients aged from 1 day from birth to 3 months 26 days between 2016 and 2024 with ultrasound signs of malrotation detected by microconvex and linear transducers were analyzed. 50 children were further followed up with this provisional or final diagnosis. Contrast agent passages and irrigographs were performed on an AXIOM Luminos DRF (Siemens), with 1 to 15 radiographs and up to 8 X-ray examination series obtained.

RESULTS: The most common ultrasound sign of malrotation was atypical location of mesenteric vessels, and the most common radiologic sign was left-sided location of the colon and high standing of the cecum. Assessment of the location of the duodenojejunal junction was complicated in most cases. Surgery was performed in 17 children, one of them for suspected intestinal obstruction, and a ring-shaped pancreas was found in 4 patients. The diagnosis of malrotation was made in 40 children out of 50, in 4 cases this was discordant with the radiologic findings. Concomitant abnormal location of internal organs was detected in 12 patients.

CONCLUSION: Screening ultrasound examination of all newborns should be considered as the pathology may be asymptomatic. It is important to include suspicion of malrotation in the diagnosis because of the possible manifestation of the pathology at a later age. It is currently not possible to completely abandon radiologic examination with contrast in the diagnosis of malrotation.