Ultrasound as a feasible method for the assessment of malrotation

Background: In malrotation the position of third portion of duodenum (D-3) is always intramesenteric. Demonstration of normal retromesenteric-retroperitoneal position of D-3 on ultrasound (US) can rule out malrotation. The aim of this study was to evaluate the feasibility of US in demonstrating the retroperitoneal D-3. Material/Methods: Abdominal US study was done for various indications in 60 newborns and infants (mean age: 33 days [range: 4-100 days]; 56.7% male) by an expert pediatric radiologist. The position of D-3 and its adjacent structures was evaluated in axial and longitudinal planes by linear and curved transducers. Results: A normal retromesenteric-retroperitoneal D-3 located between the superior mesenteric artery and the aorta was seen on US in all patients, including those with extensive gas in the bowel. The mean time of D-3 observation was 47.8 s (10-180 s). Ultrasound was also capable of demonstrating D-3 structure, diameter, content, adjacent structures, relative position of the superior mesenteric artery and vein. Conclusions: Ultrasound is a simple, fast and highly accurate tool to confirm the retroperitoneal position of D-3. Ultrasound can be used as a screening method for malrotation eliminating the need for unnecessary barium studies.