Skip to main content
Log in

CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript



Demonstration of the third duodenal segment (D3) in retroperitoneal location has been recently proposed as a method for excluding malrotation.


This study was performed to determine whether a retroperitoneal third duodenal segment can reliably exclude malrotation.

Materials and methods

CTs of 38 patients with proven malrotation and 100 patients without malrotation were evaluated for the location of the duodenum/proximal small bowel, and the relationship of the superior mesenteric vein (SMV) to superior mesenteric artery (SMA).


The D3 segment was in normal retroperitoneal location in 100% of control patients, compared to 2.5% or (1 of 38) of patients with malrotation. Nine of 11 patients (91%) with malrotation imaged prior to surgery had the proximal bowel in an abnormal location, while all 100 control patients had it in a normal location. The SMV was in normal relationship to the SMA in 11/38 patients (29%) with malrotation, compared to 79% of normal controls. In 10 controls, a branch of the SMV was partially wrapped around the SMA, potentially mimicking partial mesenteric volvulus.


A retroperitoneal location of the D3 segment makes the diagnosis of malrotation unlikely but not impossible. Additional imaging of the duodenojejunal junction or cecum may be necessary to reliably exclude intestinal malrotation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Applegate KE (2009) Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol 39(Suppl 2):S161–S163

    Article  PubMed  Google Scholar 

  2. Yousefzadeh DK (2009) The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation. Pediatr Radiol 39:S172–S177

    Article  PubMed  Google Scholar 

  3. Yousefzadeh DK, Kang L, Tessicini L (2010) Assessment of retromesenteric position of the third portion of the duodenum: a US feasibility study in 33 newborns. Pediatr Radiol 40:1476–1484

    Article  PubMed  Google Scholar 

  4. Nichols DM, Li DK (1983) Superior mesenteric vein rotation: a CT sign of midgut malrotation. AJR 141:707–708

    PubMed  CAS  Google Scholar 

  5. Orzech N, Navarro OM, Langer LC (2006) Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg 41:1005–1009

    Article  PubMed  Google Scholar 

  6. Applegate KE, Anderson JM, Klatte EC (2006) Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics 26:1485–1500

    Article  PubMed  Google Scholar 

  7. Snyder WH, Chaffin L (1954) Embryology and pathology of the intestinal tract: presentation of 40 cases of malrotation. Ann Surg 140:368–379

    Article  PubMed  Google Scholar 

  8. Clark P, Ruess L (2005) Counterclockwise barber-pole sign on CT: SMA/SMV variance without midgut malrotation. Pediatr Radiol 35:1125–1127

    Article  PubMed  Google Scholar 

  9. Pracros JP, Sann L, Genin G et al (1992) Ultrasound diagnosis of midgut volvulus: the “whirlpool” sign. Pediatr Radiol 22:18–20

    Article  PubMed  CAS  Google Scholar 

  10. Fisher JK (1981) Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology 140:145–146

    PubMed  CAS  Google Scholar 

  11. Weinberger E, Winters WD, Liddell RM et al (1992) Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery. AJR 159:825–828

    PubMed  CAS  Google Scholar 

  12. Daneman A (2009) Malrotation: the balance of evidence. Pediatr Radiol 39(Suppl 2):S164–S166

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to George A. Taylor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, G.A. CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation. Pediatr Radiol 41, 1378–1383 (2011).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: