Pediatric Radiology

, Volume 44, Issue 5, pp 542–551

Heterotaxy syndromes and abnormal bowel rotation

  • Beverley Newman
  • Raji Koppolu
  • Daniel Murphy
  • Karl Sylvester
Original Article

DOI: 10.1007/s00247-013-2861-4

Cite this article as:
Newman, B., Koppolu, R., Murphy, D. et al. Pediatr Radiol (2014) 44: 542. doi:10.1007/s00247-013-2861-4



Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial.


To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management.

Materials and methods

Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings.


Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review.


We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates.


HeterotaxyMalrotationNon-rotationChildrenComputed tomographyMagnetic resonance imagingUpper gastrointestinal series

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Beverley Newman
    • 1
  • Raji Koppolu
    • 2
  • Daniel Murphy
    • 3
  • Karl Sylvester
    • 2
  1. 1.Department of RadiologyStanford University, Lucile Packard Children’s HospitalStanfordUSA
  2. 2.Department of SurgeryLucile Packard Children’s Hospital at StanfordStanfordUSA
  3. 3.Department of CardiologyLucile Packard Children’s Hospital at StanfordStanfordUSA