AJR 2002; 179:1429-1435.
Pickhardt PJ, Bhalla S.
Congenital malrotation of the mid-gut often presents within the first month of life. Pediatric radiologists are, therefore, consciously attuned to this malady and its associated imaging features. The overall incidence of malrotation, however, is unknown because some patients will present years later or remain asymptomatic for life. Because presentation is nonspecific and the index of suspicion for malrotation progressively decreases in the older population, the clinical diagnosis is usually not considered in the initial evaluation. At least some of the surgical literature, however, seems to favor surgery for malrotation regardless of patient age. This recommendation further underscores the importance of recognizing this unsuspected diagnosis on imaging. We review the imaging features of malrotation in adolescents and adults in the context of various clinical scenarios in which it may be encountered. Abdominal CT findings will be emphasized because abdominal CT is a frequent means of detection in patients with malrotation.