Binu Vineet, Nicholson Cheryl, Cundy Thomas, Gent Roger, Piotto Lino, Taranath Ajay, Goh Day Way
Department of Paediatric Surgery, Women's and Children's Hospital, South Australia, Australia.
Department of Paediatric Surgery, Women's and Children's Hospital, South Australia, Australia.
J Pediatr Surg. 2021 Dec;56(12):2224-2228. doi: 10.1016/j.jpedsurg.2021.04.009. Epub 2021 Apr 20.
Upper gastrointestinal contrast study is considered the gold standard investigation to diagnose intestinal malrotation and midgut volvulus which is potentially devastating condition. Ultrasound imaging is an alternative but has been considered unreliable due to significant false negative results. At our institution we have been using ultrasound imaging as the first line investigation to diagnose malrotation since 2008 with a preliminary study of 139 patients published in 2014. This is an ongoing audit of a further much larger cohort of patients to determine the efficacy and safety of ultrasound imaging in the diagnosis of intestinal malrotation.
Following ethics approval, a retrospective analysis of a prospectively collected patient database undergoing ultrasound scans to exclude malrotation at our centre was performed from 2012 to 2019.
539 patients underwent ultrasound to assess for malrotation. The mean age of presentation was 365 days (median 30 days, mode 1 day). Malrotation was diagnosed in 17 with 5 having volvulus, with findings confirmed at surgery. 12 had equivocal findings and subsequent contrast studies ruled out malrotation. The remaining 510 patients with no evidence of malrotation were managed conservatively.
We have shown ultrasound to be a safe and effective tool to assess intestinal malrotation without exposure to ionizing radiation.
Level IV.
上消化道造影检查被认为是诊断肠旋转不良和中肠扭转的金标准检查方法，而中肠扭转是一种潜在的毁灭性疾病。超声成像虽是一种替代方法，但由于存在大量假阴性结果，一直被认为不可靠。自2008年以来，在我们机构一直将超声成像作为诊断旋转不良的一线检查方法，并于2014年发表了对139例患者的初步研究。这是一项对更多患者队列进行的持续审计，以确定超声成像在诊断肠旋转不良中的有效性和安全性。
在获得伦理批准后，对2012年至2019年期间在我们中心接受超声扫描以排除旋转不良的前瞻性收集的患者数据库进行了回顾性分析。
539例患者接受了超声检查以评估旋转不良。就诊时的平均年龄为365天（中位数30天，众数1天）。诊断出17例旋转不良，其中5例伴有扭转，手术结果证实了这些发现。12例结果不明确，随后的造影检查排除了旋转不良。其余510例无旋转不良证据的患者接受了保守治疗。
我们已证明超声是一种安全有效的评估肠旋转不良的工具，且无需暴露于电离辐射。
四级。
