Despite reports of imaging characteristics that would identify intestinal rotational anomalies that predispose to volvulus, most paediatric surgeons would proceed to an operation when imaging is suggestive. The aim of this study was to test the performance of the upper gastrointestinal (UGI) contrast studies and its restrictions that lead to false positive or false negative reports.
Methods We performed a retrospective analysis of patients investigated for malrotation, or treated for it over 5 years (2008–2013). Radiology reports were graded as positive, equivocal or negative. If the study was inconclusive, further imaging or treatment was dictated by clinical status.
Results 279 patients were investigated due to suspected malrotation, while in 24 patients malrotation was an incidental finding. In total, 86 patients underwent a Ladd’s procedure. If the definite positive and equivocal reports were considered as positive regarding the intention to intervene surgically, the sensitivity of UGIS was 94%, specificity was 95.4%, with 18% false positive results and 1.4% false negatives. In the 11 patients with proven false positive results, two had a negative laparotomy, but all the remaining 9 patients had surgical findings (including 3 duodenal stenoses, and 3 intestinal atresias).
Conclusion The UGI series proved to be very sensitive and specific for the diagnosis of malrotation, when the clinical pathway dictates prompt surgical intervention in the presence of positive or at least non-negative radiology report. This approach can lead to a significant number of false positive results, although other surgically treatable pathology is commonly identified in these patients.