Orzech Neil, Navarro Oscar M, Langer Jacob C
Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada ON M5G 1X8.
J Pediatr Surg. 2006 May;41(5):1005-9. doi: 10.1016/j.jpedsurg.2005.12.070.
Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We aimed to determine the accuracy of this technique.
All children undergoing both upper gastrointestinal series (UGI) and US for possible malrotation over a 3-year period were reviewed. Patients were excluded if US did not include SMV/SMA orientation or if the duodenojejunal flexure was not visualized on UGI.
Of 211 eligible patients, UGI and US were both normal in 62% and both abnormal in 15%. Forty-four had abnormal US and normal UGI (false positive, 21%), and 5 patients had normal US and abnormal UGI (false negative, 2%). Of these 5, none were found to have a short mesenteric base, which put them at risk for volvulus. Among abnormal ultrasounds, inversion of SMV/SMA and a "whirlpool" sign were more predictive for malrotation and volvulus than anterior/posterior orientation.
Ultrasonography is a good screening tool that effectively rules out malrotation at risk for volvulus. Children with an abnormal ultrasound should have an UGI or go to the operating room, depending on clinical findings.
肠旋转不良的早期诊断可预防致命的中肠扭转。超声检查（US）显示肠系膜上动脉（SMA）和静脉（SMV）方向异常与肠旋转不良有关。我们旨在确定该技术的准确性。
回顾了3年内所有因可能存在肠旋转不良而接受上消化道造影（UGI）和超声检查的儿童。如果超声检查未包括SMV/SMA方向，或上消化道造影未显示十二指肠空肠曲，则将患者排除。
在211例符合条件的患者中，62%的患者UGI和超声检查均正常，15%的患者两者均异常。44例患者超声检查异常而上消化道造影正常（假阳性，21%），5例患者超声检查正常而上消化道造影异常（假阴性，2%）。在这5例患者中，均未发现肠系膜基部短小，这使他们有发生扭转的风险。在异常超声检查中，SMV/SMA倒置和“漩涡”征比前后方向对肠旋转不良和扭转更具预测性。
超声检查是一种很好的筛查工具，能有效排除有扭转风险的肠旋转不良。超声检查异常的儿童应根据临床检查结果进行上消化道造影检查或接受手术治疗。
