INTESTINAL MALROTATION IN CHILDREN - TUTORIAL ON RADIOGRAPHIC DIAGNOSIS IN DIFFICULT CASES

PURPOSE: To analyze difficult diagnostic cases of malrotation to ident ify features crucial to accurate diagnosis. MATERIALS AND METHODS: The authors reviewed the radiographs and records of 81 symptomatic childr en who underwent surgery with a preoperative diagnosis of malrotation. Eleven had subtle rotational abnormalities (potential false-negative examinations), and 12 had false-positive upper gastrointestinal examin ations. RESULTS: Subtle signs of malrotation included unusual redundan cy of the duodenum to the right of the spine and location of the duode nojejunal junction (DJJ) medial to the left pedicle. Nevertheless, two children with variations of malrotation had normal upper gastrointest inal examinations. False-positive diagnoses resulted from failure to r ecognize normal variants: jejunum in the right upper quadrant as the s ole finding, DJJ over the left pedicle on the anteroposterior view, '' duodenum inversum,'' and ''duodenum mobile.'' Three children had bowel distention that displaced the DJJ. CONCLUSION: Diagnosis of difficult cases of malrotation may depend on recognition of anatomic subtleties . False-positive diagnoses may be avoided by appreciation of normal du odenal variants.