Diagnosing intestinal malrotation in adults by hepatobiliary scintigraphy

Abstract

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Learning Objectives: 1. To emphasize intestinal malrotation in adults as a potential mimicker of gall bladder disease. 2. To demonstrate the scintigraphic pattern of adult malrotation on hepatobiliary scan. 3. To illustrate the radiological findings of malrotation on upper GI series and CT scan.

Abstract Body: Hepatobiliary scintigraphy is primarily used to diagnose acute and chronic biliary tract disorders. However, it can also be helpful in diagnosing unsuspected nonbiliary pathology such as intestinal malrotation. Malrotation in adults presents with non-specific abdominal symptoms including intermittent abdominal pain,vomiting, diarrhea and malabsorption; symptoms mimicking gallbladder disease. Reversal of the normal relationship of the superior mesenteric artery(SMA) and superior mesenteric vein (SMV) on ultrasound or CT can suggest malrotation. Due to the relatively low incidence of malrotation in adults, these findings can be overlooked by adult radiologists. Malrotation can be suspected on a hepatobiliary scan by identifying the presence of the first loops of small bowel on the right side of the abdomen instead of usual location on the left. When interpreting a hepatobiliary scan, adequate attention must be paid to bowel position, if malrotation is to be detected. Our exhibit will illustrate the pattern of adult malrotation by hepatobiliary scintigraphy, an upper GI series, and CT scan.