Imaging of Malrotation and Midgut Volvulus

Imaging plays a crucial role in diagnosis of patients with suspected malrotation with or without a complicating midgut volvulus. The initial goal of diagnostic imaging in acutely symptomatic children is to detect potentially life-threatening volvulus, helping decrease the time to surgery and prevent bowel ischemia. The clinical imaging standard of care for diagnosis is fluoroscopic upper GI series (UGI), which assesses the position of the duodenal jejunal junction. However, there is increasing interest and supporting evidence in diagnosing malrotation and midgut volvulus with ultrasound because ultrasound is fast, lacks ionizing radiation, and is widely available.