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Factors associated with diagnostic ultrasound for midgut volvulus and relevance of the non-diagnostic examination

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Abstract

Background

Few reports explore the frequency and factors associated with diagnostic ultrasound (US) for midgut volvulus.

Objective

To evaluate predictive factors for diagnostic US for midgut volvulus and clinical outcomes of patients with non-diagnostic US.

Materials and methods

This retrospective study included infants imaged for midgut volvulus with US. Exams were rated as diagnostic (midgut volvulus present or absent) or non-diagnostic by a pediatric radiologist, and in cases of disagreement with the original report, an additional pediatric radiologist was the tie-breaker. For each exam, the following were recorded: age, weight, respiratory support, exam indication, sonographer experience, and gaseous dilated bowel loops on radiography. Logistic regression models with “stepwise” variable selection were used to investigate the association of diagnostic US for midgut volvulus with each of the independent variables.

Results

One hundred nineteen patients were imaged. US was diagnostic in 74% (88/119) of patients. In subsets of patients presenting with bilious emesis or age <28 days, US was diagnostic in 92% (22/24) and 90% (53/59), respectively. Logistic regression suggested that symptom type (bilious vs other) was the best predictor of diagnostic US (type 3 P=0.02). Out of 26 patients with available radiographs, US was diagnostic in 92% (12/13) of patients without bowel dilation on radiographs compared to 62% (8/13) of patients with bowel dilation (P=0.16). Weight, respiratory support, and sonographer experience did not differ between groups. Two sick neonates, ages 2 days and 30 days, in whom the primary clinical concern was dropping hematocrit and sepsis, respectively, had non-diagnostic ultrasounds in the setting of bowel dilation on radiography. Both were found to have midgut volvulus at surgery and both expired.

Conclusion

US was most frequently diagnostic in patients with bilious emesis or age less than 28 days. Non-diagnostic US for midgut volvulus must prompt a predetermined follow-up strategy, such as an additional imaging study (e.g., upper GI series), particularly in a sick child, as non-diagnostic US may miss midgut volvulus.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Nguyen HN, Sammer MBK, Ditzler MG et al (2021) Transition to ultrasound as the first-line imaging modality for midgut volvulus: keys to a successful roll-out. Pediatr Radiol 51:506–515

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wong K, Van Tassel D, Lee J et al (2020) Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice. J Pediatr Surg 55:2614–2617

    Article  PubMed  Google Scholar 

  3. Binu V, Nicholson C, Cundy T et al (2021) Ultrasound imaging as the first line of investigation to diagnose intestinal malrotation in children: Safety and efficacy. J Pediatr Surg 56:2224–2228

    Article  PubMed  Google Scholar 

  4. Karaman İ, Karaman A, Çınar HG et al (2018) Is color Doppler a reliable method for the diagnosis of malrotation? J Med Ultrason 452001:59–64

    Article  Google Scholar 

  5. Nguyen HN, Navarro OM, Guillerman RP et al (2021) Untwisting the complexity of midgut malrotation and volvulus ultrasound. Pediatr Radiol 51:658–668

    Article  PubMed  Google Scholar 

  6. Kumar B, Kumar M, Kumar P et al (2017) Color Doppler-an effective tool for diagnosing midgut volvulus with malrotation. Indian J Gastroenterol 36:27–31

    Article  PubMed  Google Scholar 

  7. Zhang W, Sun H, Luo F (2017) The efficiency of sonography in diagnosing volvulus in neonates with suspected intestinal malrotation. Medicine (Baltimore) 96:e8287

    Article  PubMed  Google Scholar 

  8. Zhou LY, Li SR, Wang W et al (2015) Usefulness of sonography in evaluating children suspected of malrotation: comparison with an upper gastrointestinal contrast study. J Ultrasound Med 34:1825–1832

    Article  PubMed  Google Scholar 

  9. Esposito F, Vitale V, Noviello D et al (2014) Ultrasonographic diagnosis of midgut volvulus with malrotation in children. J Pediatr Gastroenterol Nutr 59:786–788

    Article  PubMed  Google Scholar 

  10. Alehossein M, Abdi S, Pourgholami M et al (2012) Diagnostic accuracy of ultrasound in determining the cause of bilious vomiting in neonates. Iran J Radiol 9:190–194

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nguyen HN, Sammer MB, Bales B et al (2020) Time-driven activity-based cost comparison of three imaging pathways for suspected midgut volvulus in children. J Am Coll Radiol 17:1563–1570

    Article  PubMed  Google Scholar 

  12. Aidlen J, Anupindi SA, Jaramillo D, Doody DP (2005) Malrotation with midgut volvulus: CT findings of bowel infarction. Pediatr Radiol 35:529–531

    Article  PubMed  Google Scholar 

  13. Kassner EG, Kottmeier PK (1975) Absence and retention of small bowel gas in infants with midgut volvulus: mechanisms and significance. Pediatr Radiol 4:28–30

    Article  CAS  PubMed  Google Scholar 

  14. Patino MO, Munden MM (2004) Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med 23:397–401

    Article  PubMed  Google Scholar 

  15. Taori K, Sanyal R, Attarde V et al (2006) Unusual presentations of midgut volvulus with the whirlpool sign. J Ultrasound Med 25:99–103

    Article  PubMed  Google Scholar 

  16. El-Chammas K, Malcolm W, Gaca AM et al (2006) Intestinal malrotation in neonates with nonbilious emesis. J Perinatol 26:375–377

    Article  CAS  PubMed  Google Scholar 

  17. Nguyen HN, Navarro OM, Bloom DA et al (2022) Ultrasound for midgut malrotation and midgut volvulus: AJR expert panel narrative review. AJR Am J Roentgenol 218:931–939

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA

    Alexander Maad El-Ali, C. Austen Hartwell, Jaimelee Prestano, Naomi Strubel & Shailee Lala

  2. NYU Grossman School of Medicine, Long Island Campus, 660 First Avenue, New York, NY, 10016, USA

    Selin Ocal

  3. Department of Statistics, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA

    Judith D. Goldberg & Xiaochun Li

  4. Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, 259 First Street, Mineola, NY, 11501, USA

    Ranjith Kamity

  5. Division of Pediatric Surgery, Department of Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 10W, New York, NY, 10016, USA

    Laura Martin

Authors
  1. Alexander Maad El-Ali
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  4. Judith D. Goldberg
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  5. Xiaochun Li
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  7. Ranjith Kamity
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  8. Laura Martin
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Contributions

The authors declare that they had full access to all of the data in this study and the authors take complete responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed and approved the final manuscript. Author contributions are summarized:

A.M.E.: study design, data collection, data analysis, manuscript preparation, image interpretation

R.K.: study design

L.M.: study design

N.S.: study design, data collection, data analysis, manuscript preparation, image interpretation

S.L.: study design, data collection, data analysis, manuscript preparation

J.P.: study design, data collection

X.L.: data analysis, manuscript preparation

J.D.G.: data analysis, manuscript preparation

C.A.H.: Data collection

S.O.: Data collection

Corresponding author

Correspondence to Alexander Maad El-Ali.

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El-Ali, A.M., Ocal, S., Hartwell, C.A. et al. Factors associated with diagnostic ultrasound for midgut volvulus and relevance of the non-diagnostic examination. Pediatr Radiol 53, 2199–2207 (2023). https://doi.org/10.1007/s00247-023-05727-1

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  • DOI: https://doi.org/10.1007/s00247-023-05727-1

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