Wk 2, Case 3 - Review

EXAM: Upper GI Fluoroscopic Examination with Small Bowel Follow-through

INDICATION: 8-year-old girl with vomiting.

TECHNIQUE: Multiple fluoroscopic images were obtained during and after the administration of enteric contrast in a serial fashion, to monitor the transit of contrast through the bowel. The exam was terminated when contrast was visualized beyond the terminal ileum and within the colon.

FINDINGS:

On initial images, contrast is seen within the stomach and normal-appearing proximal small bowel. However, the 3rd and 4th portions of the duodenum are seen to have an abnormal position, and the duodenojejunal junction is visualized in the right hemiabdomen. Further transit of contrast reveals an abnormal position of the terminal ileum and cecum in the left mid-abdomen.

IMPRESSIONS:

Abnormal course of the distal duodenum, with position of the duodenojejunal junction on the right, and position of the terminal ileum and cecum on the left. These findings are diagnostic of intestinal malrotation. No fluoroscopic evidence of midgut volvulus.