E2177. Identifying Intestinal Malrotation in Adults by Using a New CT Classification
  1. Ziman Xiong; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
  2. Yaqi Shen; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
To perform a radiologic classification of intestinal malrotation by retrospectively analyzing the Computed Tomography (CT) data of adult patients diagnosed with malrotation in our institution.

Materials and Methods:
We included 262 adult patients diagnosed with intestinal malrotation since 2011, all of whom underwent CT scans of the abdomen or intestines. Gender and age were recorded for all patients, while three radiologists independently evaluated and recorded each patient’s CT images of the duodenal structure, the distribution of the jejunum and cecum, and the location of the superior mesenteric artery (SMA) in relation to the superior mesenteric vein (SMV). We developed classification criteria based on whether the duodenum crossed the midline of the abdomen, the location of the jejunum and the cecum (Dy/nJr/m/lCr/m/l/p; D: Duodenum, y: yes, n: no, J: Jejunum, r: right, m: middle, l: left, C: Cecum, p: pelvis).

The average age of our patients was 50.6±15.2 years, and males accounted for 64.9% (170/262) of all cases. In 34.7% (91/262) of the cases, the duodenum did not cross the midline. In 98.8% (259/262) of the cases, jejunum was mainly located in the right abdomen, while only 1 case was located in the middle abdomen and 2 cases were located in the left abdomen. The cecum was located in the right side of the abdomen in 88.6% (232/262) of cases, and in the mid-abdomen, left side of the abdomen and in the pelvis in 4, 21 and 5 cases, respectively. SMA located on the right side of the SMV was seen in 9.2% (24/262) of cases. In addition, all cases were classified into ten categories according to duodenum, jejunum and cecum, with DyJrCr being the most frequent, accounting for 59.5% (156/262), followed by DnJrCr with 28.2% (74), and then DnJrCl (12, 4.6%), DyJrCl (7, 2.7%), DnJrCp (5, 1.9%), DyJrCm (4, 1.5%), DyJrCp (1, 0.4%), DyJmCr (1, 0.4%), DyJlCr (1, 0.4%), and DyJlCl (1, 0.4%).

The CT classification of intestinal malrotation allows radiologists to make a timely initial diagnosis of the suspected patient, while aiding surgeons in preoperative evaluation and decision-making.