Fetal MRI of hereditary multiple intestinal atresia with postnatal correlation

Prenatal diagnosis of intestinal nonrotation using magnetic resonance imaging: Is it possible?

BACKGROUND

Malrotation of the bowel refers to any variation in the rotation and fixation of the gastrointestinal tract during the first trimester and is most commonly detected postnatally. Nonrotation of the bowel and incomplete rotation of the bowel are subtypes of malrotation.

OBJECTIVE

To determine if the nonrotation subtype of malrotation of the bowel can be detected on prenatal magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Cases from 2012 to 2018 with nonrotation of the bowel without obstruction confirmed by imaging, surgery and/or autopsy were compared to prenatal imaging. Prenatal imaging was retrospectively reviewed to determine if prenatal diagnosis of malrotation could be made. Exclusion criteria included diaphragmatic hernia, omphalocele and gastroschisis.

RESULTS

Ten cases of nonrotation diagnosed postnatally by upper gastrointestinal series (upper GI)/small bowel follow-through (SBFT) or autopsy had prenatal MRI. Prenatal MR studies were performed for assessment of heterotaxy syndrome with congenital heart disease (6/10), congenital heart disease with additional anomalies (suspected VACTERL [vertebral, anorectal, cardiac, tracheoesophageal, renal, limb] and suspected lung agenesis, ventriculomegaly) (3/10) and skeletal dysplasia (1/10). Eight upper GI/SBFT cases demonstrated nonrotation of the bowel without obstruction with the small bowel completely on one side of the abdomen contralateral to the stomach and the colon ipsilateral to the stomach; four cases were confirmed by surgery. The small bowel in one upper GI/SBFT case was unilateral contralateral to the stomach with a meandering colon. One case had nonrotation diagnosed at autopsy. There were no cases of postnatal midgut volvulus. Retrospective review of the 10 cases had prenatal MRI performed between 23 and 37 weeks of gestation. The coronal plane was the most optimal plane to assess the position of the stomach, small bowel and colon in relationship to each other. The small bowel was best assessed on T2-weighted images while the colon was best assessed on T1-weighted images. A nonrotated position of the small bowel was present in all 10 fetal MRI cases mirroring postnatal findings, with the small bowel contralateral to the stomach in 9/10 cases and ipsilateral to the stomach (in the right abdomen) in 1/10 cases. The colon was visualized by prenatal MRI in 9/10 cases, with 1 case limited due to a lack of T1-weighted imaging. A nonrotated position of the colon contralateral to the small bowel was present in 7/9 cases. In 2/9 cases, the colon was wandering, positioned on both sides of the midline. Colonic position in all nine cases matched postnatal findings. No cases presented with prenatal bowel obstruction.

CONCLUSION

Detection of nonrotation of the bowel is possible on prenatal MRI.

Prenatal diagnosis of gastric and small bowel atresia: a case series and review of the literature

OBJECTIVE

To describe seven cases of gastrointestinal tract (GIT) obstructions and to report a skewed review of the literature.

METHODS

We performed a search of our permanent perinatal database about cases with prenatal ultrasound and MRI diagnosis of gastrointestinal tract obstructions between 2006 and 2013. All cases were followed until hospital discharge and pre-natal diagnosis were confirmed by fetal MRI, postnatal imaging and/or intra-operative findings. Maternal age, parity, gestational age at diagnosis, ultrasound findings, gestational age at delivery, Apgar scores at 1 and 5 min and postnatal outcome have been recorded.

RESULTS

We identified seven cases of gastric and small bowel atresia. Karyotype was normal in six cases and abnormal in one co-twin [46,XY dup (20) (qq13.1q13.3)dn] of a dichorionic-diamniotic pregnancy. The mean ± SD for maternal age, gestational age at diagnosis, gestational at delivery, birth weight and Apgar scores at 1 and 5 min were 30.8 ± 4.8 years, 29.8 ± 3.7 weeks, 2507.5 ± 727.5 g and 5.6 ± 2.1, 7.6 ± 1.6, respectively. All fetuses' undergone surgical procedures in the postnatal period and all of them were discharged live from the hospital.

CONCLUSION

Prompted antenatal detection of gastrointestinal tract obstruction using ultrasound proved to be diagnostic in all cases. Fetal MRI aid was a useful complementary diagnostic investigation. Correct pre-natal diagnosis allows adequate counseling, delivery planning and management care by a multidisciplinary team.

The importance of antenatal diagnosis of congenital duodenal obstruction

INTRODUCTION

The aim of this study was to compare the outcome of operated newborns that had an antenatal diagnosis of congenital duodenal obstruction (CDO) with those who had a late diagnosis in the postpartum period.

MATERIALS AND METHODS

The newborns that were operated with the diagnosis of CDO in our department were retrospectively recorded. The patients were grouped according to the time of diagnosis; the ones who had an antenatal diagnosis were assigned to group 1, while the ones that had a diagnosis in the postpartum period were assigned to group 2. The groups were compared in terms of their pregnancy weeks at the time of birth, birth weight, additional congenital anomalies, the type of obstruction, the procedures that are applied, the day of operation, the time for oral feeding tolerance, the duration of hospital stay, and pre- and post-operative complications.

RESULTS

Fifteen patients with a diagnosis of CDO were operated on in our department between 2009 and 2014. Eight patients were male and seven patients were female. There were nine patients in group 1 and six patients in group 2. The diagnosis was confirmed in group 1 on the first day of the postpartum period. In the subanalysis, five patients had type 1 CDO and four had type 3 CDO in group 1, while five patients had type 1 CDO and one had type 3 CDO in group 2. There was not any complication in group 1 in the pre-operative period, but two patients had aspiration pneumonia and one had dehydration in group 2 pre-operatively. The mean operation day in the postpartum period was 2.34 (±0.5) days in group 1 and 7.17 (±2.04) in group 2. The time for the patient to tolerate oral feeding in the post-operative period was 11.33 (±1.80) in group 1 and 14.83 (±2.48) in group 2. The duration of hospital stay in group 1 was 20.67 (±9.81) days and 24.66 (±4.50) days in group 2. In the post-operative period, chylous ascites occured in a patient in group 1 and the post-operative period was complicated with ileus in one patient in group 2. No mortalities happened in both groups.

CONCLUSION

The prenatal diagnosis of CDO affects the pre-operative complication rate, the time for the operation in the postpartum period, the duration to start post-operative oral feeding, and the duration of hospital stay, but does not affect the mortality or the morbidity.