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A Multi-institutional Case Series With Review of Point-of-Care Ultrasound to Diagnose Malrotation and Midgut Volvulus in the Pediatric Emergency Department

Garcia, Angélica Marie, MD*; Asad, Imran, MD; Tessaro, Mark O., MD; Sivitz, Adam, MD; Osborn, Katharine, MD§; Shaahinfar, Ashkon, MD§; Leung, Stephanie K., MD; Rowe, Erin, MD; Riera, Antonio, MD*

Section Editor(s): Deanehan, J. Kate MD, RDMS; Associate Editor

doi: 10.1097/PEC.0000000000001737
Ultrasound Case Review

Point-of-care ultrasound can be used to screen for malrotation with and without volvulus in the newborn with bilious vomiting, as well as children with unexplained intermittent abdominal pain. We discuss cases where infants and children presenting to pediatric emergency departments with bilious vomiting and/or intermittent abdominal pain were initially screened for small bowel pathology with point-of-care ultrasound. Bedside findings suggestive of midgut volvulus were confirmed with radiology-performed ultrasound or upper gastrointestinal fluoroscopy. In all cases, operative findings were consistent with malrotation of the small bowel with or without evidence of midgut volvulus.

From the *Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT;

Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada;

Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ;

§Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA; and

Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX; and

Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT.

Disclosure: The authors declare no conflict of interest.

Reprints: Angélica Marie Garcia, MD, Yale-New Haven Hospital, 100 York St, Suite 1F, New Haven, CT 06510 (e-mail:

Online date: January 31, 2019

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