Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review

Midgut volvulus in association with malrotation is a pediatric surgical emergency. Prompt and accurate diagnosis is necessary to avoid bowel ischemia and necrosis, thereby reducing morbidity and mortality. Historically, the fluoroscopic upper gastrointestinal series has been the preferred imaging modality for the evaluation of both midgut malrotation and volvulus, although the use of ultrasound (US) is increasing. In this Narrative Review, we describe the findings of midgut malrotation and volvulus on US, including practical tips for acquisition and interpretation; discuss the advantages and challenges of both imaging modalities; and propose a path and safeguards for possible transition to the use of US as the first-line modality for diagnosis based on our experience in imaging children with midgut malrotation and volvulus.