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World J Radiol. Sep 28, 2014; 6(9): 730-736
Published online Sep 28, 2014. doi: 10.4329/wjr.v6.i9.730
Malrotation: Current strategies navigating the radiologic diagnosis of a surgical emergency
John J Tackett, Eleanor D Muise, Robert A Cowles
John J Tackett, Eleanor D Muise, Robert A Cowles, Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, United States
Author contributions: Tackett JJ, Muise ED and Cowles RA contributed to this work and wrote the paper.
Correspondence to: Robert A Cowles, MD, Associate Professor of Surgery, Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, Box 208062, New Haven, CT 06520, United States.
Telephone: +1-203-7852701 Fax: +1-203-7853820
Received: December 31, 2013
Revised: June 20, 2014
Accepted: July 17, 2014
Published online: September 28, 2014

The most accurate and practical imaging algorithm for the diagnosis of intestinal malrotation can be a complex and sometimes controversial topic. Since 1900, significant advances have been made in the radiographic assessment of infants and children suspected to have anomalies of intestinal rotation. We describe the current methods of abdominal imaging of malrotation along with their pros and cons. When associated with volvulus, malrotation is a true surgical emergency requiring rapid diagnosis and treatment. We emphasize the importance of close cooperation and communication between radiology and surgery to perform an effective and efficient diagnostic evaluation allowing prompt surgical decision making.

Keywords: Malrotation, Midgut volvulus, Treitz, Ladd, Heterotaxy, Infant

Core tip: Malrotation, especially when associated with midgut volvulus, is a surgical emergency that must be astutely recognized, quickly diagnosed, and emergently treated operatively. While the diagnosis depends heavily on clinical acumen and suspicion, radiologic imaging is critical in determining which patients need surgery. Surgeons and radiologists must cooperate and communicate effectively during the radiographic evaluation of a child with malrotation. Additionally, the algorithm for imaging malrotation must be adapted based upon the tools and staff available at any given institution.