Abstract
Objectives
Intestinal malrotation is largely a pediatric diagnosis, but initial detection can be made in adulthood. CT colonography (CTC) provides an ideal means for estimating prevalence. Our purpose was to evaluate the prevalence and imaging findings of intestinal malrotation in asymptomatic adults at CTC screening, as well as incomplete optical colonoscopy (OC) referral.
Methods
The CTC database of a single academic institution was searched for cases of intestinal malrotation (developmental nonrotation). Prevalence was estimated from 11,176 adults undergoing CTC. Demographic, clinical, imaging (CTC and other abdominal exams), and surgical data were reviewed.
Results
27 cases of malrotation were confirmed (mean age 62 ± 9 years; 15 M/12F), including 17 from the CTC screening cohort (0.17% prevalence) and 10 from incomplete OC (0.75% prevalence; p < 0.001). Most cases (59%; 16/27) were initially diagnosed at CTC. In 67% (12/18); the presence of malrotation was missed on at least one relevant abdominal imaging examination. At least 22% (6/27) had a history of unexplained, chronic intermittent abdominal pain. At CTC, the SMA-SMV relationship was normal in only 11% (3/27). The ileocecal valve was located in the RLQ in only 22% (6/27). Two patients (7%) had associated findings of heterotaxy (polysplenia).
Conclusions
The prevalence of intestinal malrotation was four times greater for patients referred from incomplete OC compared with primary screening CTC, likely related to anatomic challenges at endoscopy. Malrotation was frequently missed at other abdominal imaging examinations. CTC can uncover unexpected cases of malrotation in adults, which may be relevant in terms of potential for future complications.
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Abbreviations
- CTC:
-
CT colonography
- OC:
-
Optical colonoscopy
- SMA/SMV:
-
Superior mesenteric artery/vein
- ICV:
-
Ileocecal valve
- LUQ/RUQ/LLQ/LUQ:
-
Left/right upper/lower quadrant
- EHR:
-
Electronic health record
- PACS:
-
Picture archiving and communication system
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The authors of this manuscript declare relationships with the following companies: Dr. Pickhardt serves as an advisor to Bracco and Zebra and is a shareholder in SHINE, Elucent, and Cellectar. Mr. Perez has no financial disclosures to report.
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Perez, A.A., Pickhardt, P.J. Intestinal malrotation in adults: prevalence and findings based on CT colonography. Abdom Radiol 46, 3002–3010 (2021). https://doi.org/10.1007/s00261-021-02959-3
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DOI: https://doi.org/10.1007/s00261-021-02959-3