Untwisting the complexity of midgut malrotation and volvulus ultrasound

Abdominal US is emerging as an alternative to the upper gastrointestinal (GI) series as the preferred diagnostic imaging test for midgut malrotation complicated by volvulus. Unlike the upper GI series, US is free from ionizing radiation, does not require oral contrast agent, and can be performed portably and at times remotely from the interpreting radiologist, expediting diagnosis. Although some institutions do not have a standardized US protocol for midgut volvulus, many routinely use US in the setting of an infant or child with acute abdominal signs or symptoms to evaluate for common conditions such as hypertrophic pyloric stenosis, intussusception, necrotizing enterocolitis and appendicitis. Because these common conditions can overlap in age and clinical presentation with midgut volvulus, the aim of this pictorial essay is to provide instruction on the technique and diagnostic findings of midgut volvulus on US to ensure confident, accurate interpretation, and prompt treatment.

Automated summary

Abdominal ultrasound is increasingly being used as a preferred diagnostic imaging test for midgut malrotation complicated by volvulus due to its advantages over the upper gastrointestinal series. It is radiation-free, does not require oral contrast agent, and can be performed portably, expediting diagnosis. Its use in evaluating common conditions in infants or children with acute abdominal symptoms ensures confident and accurate interpretation for prompt treatment of midgut volvulus.