Duodenum and duodenal-jejunal junction in children: Position and appearance after liver transplantation

PURPOSE: To correlate upper gastrointestinal study findings of the position of the duodenum and duodenal-jejunal junction in children after liver transplantation with transplant type, age at transplantation, indication for transplantation, and history of surgery or malrotation. MATERIALS AND METHODS: Upper gastrointestinal studies in 23 children with a liver transplant were reviewed by two pediatric radiologist, and appearance and position of the duodenum and duodenal-jejunal junction were recorded. Findings were correlated with transplant type, age at transplantation, indication for transplantation, and history of surgery or malrotation. RESULTS: The duodenum and duodenal-jejunal junction were visualized on antero-posterior spot radiographs in 18 children. In 10 children, the duodenum and the junction were elevated and to the right of the spine; in two, the first and second portions of the duodenum were elevated, but the junction was normally located. These 12 children had undergone segmental liver transplantation. In the remaining six children, the duodenum and junction were normally positioned; three of these children had a whole liver transplant, and three had a segmental transplant. CONCLUSION: The duodenum and duodenal-jejunal junction are often malpositioned in children with a left lobe or left lateral segmental liver transplant. Without documented bowel obstruction, however, these children should be observed and followed up clinically.