Upper GI for malrotation

  • Patient preparation: none
  • Contrast used: low osmolar water soluble or iso osmolar water soluble or barium – never use high osmolar water soluble because if aspirated it can cause severe pulmonary edema
  • Technique:
    — Insert 8 French feeding tube into the stomach and pass tube transpyloricaly into the duodenal bulb, with patient in supine position inject 5-10 cc of contrast through the feeding tube to opacify duodenal C-loop and document the position of the duodenal-jejunal junction
    — If feeding tube tip cannot be passed out of stomach then aspirate stomach contents, place patient left side down, inject 5-10 cc of contrast through the feeding tube, turn to right side down to facilitate gastric emptying, when contrast is seen to enter 3rd/4th part of duodenum, turn the patient supine and document the position of the duodenal-jejunal junction
  • Images to obtain: AP image of duodenal-jejunal junction
  • Looking for: malrotation, midgut volvulus
  • Post procedure tasks: aspirate the stomach at the end of the exam if feeding tube still in place, flush the tube with sterile saline if it is being left in place