Katz et al. described nine findings for distinguishing normal and abnormal duodenal / jejunal positioning on upper gastrointestinal studies to detect subtle abnormalities indicative of midgut malrotation.
During development, the bowel rotates 270° anticlockwise in two locations: the foregut and midgut junction (duodenum) and midgut-hindgut location (cecum), so that the ligament of Treitz is located left to the midline and cecum reaches the right iliac fossa. Completeness of rotation can be classified into four cathegories:
Cathegory | Description |
---|---|
Normal rotation | Normal appearance of the gut, cecum in the right iliac fossa and the ligament of Treitz left to the midline |
Hydronephrosis in infants is divided into five grades that were standardized by the Society of Fetal Urology. The grading is usually based on ultrasound, ev. intravenous urography.
Grade | Description |
---|---|
Grade 0 | no splitting of renal sinus |
Grade I | urine visible in renal pelvis only |
Grade II | urine fills intrarenal pelvis, extrarenal pelvis, major calyces are dilated |
In 1977, a grading system of gastroesophageal reflux on barium study was devised. It is based on the extent of retrograde flow of barium.
Grade | Description |
---|---|
I | reflux into distal esophagus only |
II | reflux extending above carina |
III | reflux into cervical esophagus |
IV | free persistent reflux into cervical esopagus with a wide open cardia (chalasia) |