Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Malrotation and Midgut Volvulus in Children: Diagnostic Approach, Imaging Findings, and Pitfalls

소아의 장회전이상과 중장염전: 진단적 접근, 영상 소견 및 함정들

  • Jeongju Kim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • So-Young Yoo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Tae Yeon Jeon (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ji Hye Kim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김정주 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 유소영 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 전태연 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김지혜 (성균관대학교 의과대학 삼성서울병원 영상의학과)
  • Received : 2023.01.03
  • Accepted : 2023.06.20
  • Published : 2024.01.01
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Abstract

Malrotation and midgut volvulus are surgical emergencies that commonly occur within the first month of life. The classic symptom is acute bilious vomiting, while nonspecific symptoms such as recurrent abdominal pain may be present in older children. Malrotation can be associated with duodenal obstruction caused by an abnormal peritoneal fibrous band or congenital anomalies, such as an annular pancreas or a preduodenal portal vein. Volvulus can lead to bowel ischemia and a life-threatening condition, thus prompt and accurate diagnosis is crucial. Diagnosis can be made through upper gastrointestinal series, ultrasonography, and CT, with ultrasonography being preferred as a screening tool due to its rapid and accurate diagnosis, without radiation exposure, in children. This pictorial essay discusses the key imaging findings and diagnostic approaches for malrotation and midgut volvulus, as well as diagnostic pitfalls based on actual cases.

장회전이상과 이로 인한 중장염전은 생후 1개월 이내에 호발하는 외과적 응급 질환이다. 전형적인 증상은 급성 담즙성 구토이며, 유아기 이후에는 반복적인 복통과 같은 비특이적인 증상을 호소할 수 있다. 장간막 띠로 인한 십이지장 폐쇄나 고리췌장, 십이지장 전방 문맥과 같은 기형을 동반하기도 한다. 중장염전은 장의 괴사를 일으켜 생명을 위협할 수 있으므로 정확하고 빠른 진단이 중요하다. 상부 위장관 조영술, 초음파 및 CT로 진단할 수 있으며, 초음파는 소아에서 방사선 피폭 없이 빠르고 정확하게 진단할 수 있어 선별검사로 대두되고 있다. 본 임상화보에서는 장회전이상과 중장염전의 핵심적인 영상 소견 및 진단적 접근법에 대해 알아보고, 실제 증례에서 경험한 진단적 오류와 주의할 점에 대하여 살펴보고자 한다.

Keywords

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