PEDIATRIC IMAGING Iran J Radiol. 2018 April; 15(2):e15089. Published online 2018 February 12. doi: 10.5812/iranjradiol.15089. Research Article Diagnostic Value of Ultrasound and Gastrointestinal Series Findings in Detection of Pediatric Intestinal Malrotation Mina Taghavi, 1 Seyed Ali Alamdaran, 1,* and Ali Feizi 1 1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran * Corresponding author: Seyed Ali Alamdaran M.D., Department of Radiology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98-9155112578, Fax: +98-5138414499, E-mail: alamdarana@mums.ac.ir Received 2016 September 09; Revised 2017 August 21; Accepted 2017 October 09. Abstract Background: Clinical diagnosis of malrotation is difficult to achieve, especially in older children and adults as its nonspecific pre- sentations at this stage are usually neglected leading to delayed diagnosis of these cases. Objectives: In this study, we aimed to evaluate the diagnostic values of ultrasound and upper gastrointestinal (GI) series in patients with suspected intestinal malrotation. Patients and Methods: This six-year cross-sectional, prospective study was conducted in Dr. Sheikh Children’s Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from 2009 to 2015. Totally, 67 children (aged < 15 years) with clinical findings of intestinal malrotation who had evidence of malrotation in ultrasound or upper GI series were enrolled in the study. Results of radiological evaluation were compared to the final diagnosis of patients achieved from surgery. Data analysis was performed using SPSS software. Results: Of the 67 enrolled participants with clinical findings or suspected radiological signs of intestinal malrotation, about half (52.2%) were male. Patients were 2 days to 16 years (mean, 2.5 years) old. Associated anomalies were observed in 47.7% of cases. Sensitivity and specificity were 82.5% and 85.7%, respectively for GI series findings and 82.3% and 54.5%, respectively for ultrasound compared with surgical findings as a gold standard. Conclusion: Ultrasound has a similar diagnostic value compared to upper GI series. They are complementary examinations and negative ultrasound or GI series results do not necessarily rule out intestinal malrotation. Mesenteric vessels ultrasound could be used as more specific diagnostic method for the detection of intestinal rotational disorders. Keywords: Intestinal Malrotation, Children, Ultrasound, GI series 1. Background During normal fetal abdominal development, the three divisions of the GI tract (foregut, midgut, and hindgut) herniate out from the abdominal cavity. Af- terwards, they undergo a 270° counterclockwise rotation around the axis of the superior mesenteric vessel. Fol- lowing this rotation, the bowels return to the abdominal cavity, which results in the fixation of the duodenojejunal junction to the left side of the midline and the placement of the cecum in the right lower quadrant. Intestinal malrotation refers to any variation in the normal process of rotation and fixation of the GI tract. Complete arrest in the normal process of development (nonrotation) results in the placement of the duodeno- jejunal junction on the right side of the spinal column, while the total colon lies in the left abdomen. Malrota- tion is an incomplete bowel rotation that leads to abnor- mal position of the duodenojejunal junction and cecum. This wide range of abnormalities leads to various acute and chronic presentations of the disease (1, 2). Since this disease is often associated with acute symptoms such as acute midgut volvulus, catastrophic risk of ischemia, and midgut gangrene, it must be considered as a serious sur- gical emergency and must be immediately diagnosed and the patients should undergo surgery prior to development of midgut gangrene (3). In a study performed in Hawaii, the occurrence of in- testinal malrotation was reported to be 2.8 cases per 10,000 live births (4). Although intestinal malrotation usually oc- curs over the first months of life, it can present in later stages of life resulting in a more convoluted diagnostic process and its possible drawbacks (5, 6). To prevent the loss of a long segment of the small intes- tine caused by midgut volvulus, malrotation should be im- mediately ruled out in any neonate with bilious vomiting, Copyright © 2018, Iranian Journal of Radiology. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.