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Three-day-old twins are reported to have persistent bilious vomiting on the postnatal ward. You suspect midgut malrotation and it is suggested by a colleague that a Doppler ultrasound might be a better investigation than an upper gastrointestinal (UGI) contrast study, as it does not involve radiation and is non-invasive. You are uncertain which test is best.
Structured clinical question
In an infant with bilious vomiting [patient], is a Doppler ultrasound [intervention] superior to an UGI contrast study [comparison] for the diagnosis of malrotation [outcome]?
A search of the Cochrane database of systematic reviews and BestBETS website identified no relevant articles.
An Ovid Medline (1950–2010) search was performed using the search terms: Intestinal Volvulus/or malrotation.mp. AND ultrasound.mp.
Searches were limited to English language, human, infant (birth–23 months).
A total of 37 articles were retrieved, and the abstracts were reviewed. Four relevant studies were identified (see table 2).
Malrotation of the midgut is a congenital abnormality …