Mitteldarm-Malrotation und Volvulus

◆Diagnostische Schlüsselhinweise

• 1US 'Whirlpool Sign' — VMS und Mesenterium rotieren um AMS (pathognomonisch für Volvulus)
• 2US AMS/VMS-Positionsumkehr — VMS links oder anterior der AMS statt rechts (Malrotationszeichen)
• 3DJ-Junction rechts oder in Mittellinie im UGI — Goldstandard für Malrotationsdiagnose (Sensitivität >95%)
• 4Biliöses (grünes, galliges) Erbrechen beim Neugeborenen — Malrotation-Volvulus bis zum Ausschluss annehmen
• 5UGI 'Korkenzieher-Zeichen' — Spiralkonfiguration von Duodenum/Jejunum (Volvulus)

♦Pathophysiologie

Differentialdiagnostische Tipps

• →Duodenalatresie: Double-Bubble-Zeichen, galliges Erbrechen aber kein Volvulus, Down-Syndrom-Assoziation
• →Jejunal-/Ilealatresie: Triple-/Multiple-Bubble-Zeichen, mehr proximale Dilatation
• →Pylorusstenose: nicht-galliges projektilartiges Erbrechen, Pylorusmuskulaturhypertrophie, 2-8 Wochen
• →NEC: Frühgeboren, Pneumatosis intestinalis, portales Venengas

●Klinische Bedeutung

Einer der dringlichsten chirurgischen Notfälle der Neugeborenenperiode. Malrotation/Volvulus muss bei jedem Neugeborenen mit galligem (grünem) Erbrechen ausgeschlossen werden — verzögerte Diagnose kann zu Darmnekrose, Kurzdarmsyndrom und Tod führen. Das Whirlpool-Zeichen im US ermöglicht eine schnelle Diagnose. Das notfallmäßige Ladd-Verfahren ist lebensrettend. Die Prognose ist exzellent, wenn die Operation vor vaskulärer Kompromittierung durchgeführt wird. Massive Darmnekrose kann sich bei verzögerten Fällen entwickeln.

Referenzen

• Defined by Defined by Defined by Defined by Defined by Defined by ACR Appropriateness Criteria: Vomiting in Infants Up to 3 Months of Age. 2021.
• Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Orzech N, et al. Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg. 2006;41(5):1005-9.
• Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Strouse PJ. Disorders of intestinal rotation and fixation ('malrotation'). Pediatr Radiol. 2004;34(11):837-51.
• Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Sizemore AW, et al. Diagnostic performance of the upper gastrointestinal series for midgut malrotation in pediatric patients. Pediatr Radiol. 2008;38(5):518-28.
• Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Defined by Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17(3):326-31.