Long F R, Kramer S S, Markowitz R I, Taylor G E, Liacouras C A
Department of Radiology, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Radiology. 1996 Mar;198(3):775-80. doi: 10.1148/radiology.198.3.8628870.
To analyze difficult diagnostic cases of malrotation to identify features crucial to accurate diagnosis.
The authors reviewed the radiographs and records of 81 symptomatic children who underwent surgery with a preoperative diagnosis of malrotation. Eleven had subtle rotational abnormalities (potential false-negative examinations), and 12 had false-positive upper gastrointestinal examinations.
Subtle signs of malrotation included unusual redundancy of the duodenum to the right of the spine and location of the duodenojejunal junction (DJJ) medial to the left pedicle. Nevertheless, two children with variations of malrotation had normal upper gastrointestinal examinations. False-positive diagnoses resulted from failure to recognize normal variants: jejunum in the right upper quadrant as the sole finding, DJJ over the left pedicle on the anteroposterior view, "duodenum inversum," and "duodenum mobile." Three children had bowel distention that displaced the DJJ.
Diagnosis of difficult cases of malrotation may depend on recognition of anatomic subtleties. False-positive diagnoses may be avoided by appreciation of normal duodenal variants.
分析旋转不良的疑难诊断病例，以确定准确诊断的关键特征。
作者回顾了81例术前诊断为旋转不良且接受手术的有症状儿童的X线片和病历记录。11例有细微的旋转异常（可能为假阴性检查），12例上消化道检查结果为假阳性。
旋转不良的细微征象包括十二指肠在脊柱右侧异常冗长以及十二指肠空肠交界部（DJJ）位于左肾蒂内侧。然而，两名旋转不良变异患儿的上消化道检查结果正常。假阳性诊断是由于未识别正常变异所致：右上腹空肠为唯一发现、前后位片上DJJ位于左肾蒂上方、“十二指肠反位”以及“可移动十二指肠”。三名患儿出现肠扩张，导致DJJ移位。
旋转不良疑难病例的诊断可能取决于对解剖细微之处的识别。通过了解正常十二指肠变异可避免假阳性诊断。
