Factors associated with diagnostic ultrasound for midgut volvulus and relevance of the non-diagnostic examination

Alexander Maad El-Ali; Selin Ocal; C Austen Hartwell; Judith D Goldberg; Xiaochun Li; Jaimelee Prestano; Ranjith Kamity; Laura Martin; Naomi Strubel; Shailee Lala

doi:10.1007/s00247-023-05727-1

Factors associated with diagnostic ultrasound for midgut volvulus and relevance of the non-diagnostic examination

Pediatr Radiol. 2023 Oct;53(11):2199-2207. doi: 10.1007/s00247-023-05727-1. Epub 2023 Aug 17.

Authors

Affiliations

¹ Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA. alexander.el-ali@nyulangone.org.
² NYU Grossman School of Medicine, Long Island Campus, 660 First Avenue, New York, NY, 10016, USA.
³ Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
⁴ Department of Statistics, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
⁵ Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, 259 First Street, Mineola, NY, 11501, USA.
⁶ Division of Pediatric Surgery, Department of Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 10W, New York, NY, 10016, USA.

PMID: 37589763
DOI: 10.1007/s00247-023-05727-1

Abstract

Background: Few reports explore the frequency and factors associated with diagnostic ultrasound (US) for midgut volvulus.

Objective: To evaluate predictive factors for diagnostic US for midgut volvulus and clinical outcomes of patients with non-diagnostic US.

Materials and methods: This retrospective study included infants imaged for midgut volvulus with US. Exams were rated as diagnostic (midgut volvulus present or absent) or non-diagnostic by a pediatric radiologist, and in cases of disagreement with the original report, an additional pediatric radiologist was the tie-breaker. For each exam, the following were recorded: age, weight, respiratory support, exam indication, sonographer experience, and gaseous dilated bowel loops on radiography. Logistic regression models with "stepwise" variable selection were used to investigate the association of diagnostic US for midgut volvulus with each of the independent variables.

Results: One hundred nineteen patients were imaged. US was diagnostic in 74% (88/119) of patients. In subsets of patients presenting with bilious emesis or age <28 days, US was diagnostic in 92% (22/24) and 90% (53/59), respectively. Logistic regression suggested that symptom type (bilious vs other) was the best predictor of diagnostic US (type 3 P=0.02). Out of 26 patients with available radiographs, US was diagnostic in 92% (12/13) of patients without bowel dilation on radiographs compared to 62% (8/13) of patients with bowel dilation (P=0.16). Weight, respiratory support, and sonographer experience did not differ between groups. Two sick neonates, ages 2 days and 30 days, in whom the primary clinical concern was dropping hematocrit and sepsis, respectively, had non-diagnostic ultrasounds in the setting of bowel dilation on radiography. Both were found to have midgut volvulus at surgery and both expired.

Conclusion: US was most frequently diagnostic in patients with bilious emesis or age less than 28 days. Non-diagnostic US for midgut volvulus must prompt a predetermined follow-up strategy, such as an additional imaging study (e.g., upper GI series), particularly in a sick child, as non-diagnostic US may miss midgut volvulus.

Keywords: Bowel ultrasound; Midgut volvulus; Pediatric ultrasound; Ultrasound.