MALROTATION IN PATIENTS WITH DUODENAL ATRESIA - A TRUE ASSOCIATION ORAN EXPECTED FINDING ON POSTOPERATIVE UPPER GASTROINTESTINAL BARIUM STUDY

We retrospectively reviewed the imaging and surgical findings in 17 pa tients with duodenal atresia to determine (a) the frequency of coexist ent malrotation in patients with duodenal atresia and (b) the reliabil ity of the upper gastrointestinal barium study (UGI) in differentiatin g malrotation from postoperative deformity of the duodenal sweep after repair of duodenal atresia. Postoperatively, 9 (53 %) of the 17 patie nts had UGI findings consistent with malrotation. Of these nine, only two had malrotation coexistent with duodenal atresia, while the other seven had normal midgut rotation demonstrated intraoperatively. The ra diographic appearance of malrotation was simulated in two patients in whom the ligament of Treitz had been surgically divided, in three in w hom the ligament had not been taken down, and in two in whom the statu s of the ligament was not specified in the surgical report. Although t here is an association between duodenal atresia and malrotation, this cannot be accurately documented on postoperative UGI examination. Malr otation cannot be detected preoperatively because contrast material ca nnot pass beyond the level of the atresia. Postoperatively, surgical d eformity of the duodenal sweep cannot be reliably distinguished from m alrotation.