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Montironi R, Tosto V, Quintili D, Crescenzi D, Battistoni GI, Cobellis G, Giannubilo SR, Ciavattini A. Antenatal Diagnosis and Management of Fetal Intestinal Volvulus: Case Series and Literature Review. J Clin Med 2023; 12:4790. [PMID: 37510904 PMCID: PMC10381374 DOI: 10.3390/jcm12144790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Fetal intestinal volvulus is a rare condition that can lead to hemorrhage, bowel necrosis, and urgent surgical treatment after birth. Thus, prompt diagnosis and treatment are essential to avoiding fetal or neonatal demise. Prenatal ultrasound is a keystone tool in the diagnostic course. However, sonographic findings tend to be non-specific, with limited understanding of the pathophysiology behind their atypical presentation. With a literature review and a case series, we aim to optimize the antenatal diagnosis and management of this rare but life-threatening condition. Six cases from our institution were retrospectively analyzed over 12 years. A literature review was conducted until December 2022. A total of 300 articles matched the keyword "Fetal volvulus", and 52 studies were eligible for the review. Our 6 cases are added to the 107 cases reported in the literature of fetal intestinal volvulus with antenatal ultrasound assessment and without associated gastroschisis or omphalocele. Several prenatal symptoms and ultrasound markers, even if not specific, were more frequently reported. Different experiences of management were described regarding follow-up, the timing of delivery, the mode of delivery, and surgery outcomes. This paper highlights the importance of suspecting and assessing fetal volvulus at routine ultrasound scans, describing the most frequent antenatal presentations and management in order to improve fetal and neonatal outcomes.
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Affiliation(s)
- Ramona Montironi
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Valentina Tosto
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Dayana Quintili
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Daniele Crescenzi
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Giovanna Irene Battistoni
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Giovanni Cobellis
- Clinical Sciences Department, Pediatric Surgery Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Stefano Raffaele Giannubilo
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Andrea Ciavattini
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
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Olutoye OO, Hammond J, Gilley J, Beckman RM, Bulathsinghala M, Keswani SS, Davies J, Mazziotti MV, Donepudi R, Belfort MA, King A, Ketwaroo PM, Lee TC. Fetal malrotation with midgut volvulus: Prenatal diagnosis and planning. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023; 93:102654. [PMID: 37292252 PMCID: PMC10249907 DOI: 10.1016/j.epsc.2023.102654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Introduction Malrotation of the intestinal tract is a congenital malformation commonly found either incidentally or after affected individuals develop signs and symptoms of intestinal obstruction. Malrotation is prone to midgut volvulus that can cause intestinal obstruction and lead to ischemia and necrosis requiring emergent surgical intervention. Rare instances of in utero midgut volvulus have been reported in the literature and carry a high mortality given the difficulty in establishing a diagnosis prior to development of signs of intestinal ischemia and necrosis. Advancements in imaging have made it possible to diagnose in utero malrotation earlier, raising the question of optimal timing of delivery, especially in cases of prenatally diagnosed midgut volvulus. In these cases, the risks of premature birth must be weighed against the risks of fetal intestinal ischemia and potential fetal demise. Case presentation This case report details an interesting presentation of intestinal malrotation with suspected midgut volvulus found on prenatal imaging at 33 weeks and 4 days' gestation. This prompted delivery of the infant at 34 weeks and 2 days' gestation with urgent operative management, within 3 hours of life, after diagnosis was confirmed postnatally. Intraoperatively, the infant was confirmed to have midgut volvulus without bowel ischemia, the intestines were reduced, and a Ladd procedure was performed without incident. The infant recovered postoperatively without complication, tolerated advancement to full volume feeds and was discharged on day of life 18. Conclusion Successful management of fetal malrotation with midgut volvulus may be accomplished by early access to a multi-disciplinary team of professionals, prompt postnatal confirmation of diagnosis, and urgent correction to minimize the risk of complications.
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Affiliation(s)
- Oluyinka O. Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - J.D. Hammond
- Division of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jamie Gilley
- Division of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ross M. Beckman
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Marie Bulathsinghala
- Division of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sonya S. Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Davies
- Division of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mark V. Mazziotti
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Roopali Donepudi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Michael A. Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Pamela M. Ketwaroo
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Timothy C. Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
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Shen AW, Kothari A, Flint A, Kumar S. Prenatal imaging features and perinatal outcomes of foetal volvulus-A literature review. Prenat Diagn 2022; 42:192-200. [PMID: 34981841 DOI: 10.1002/pd.6083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes. METHODS A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance. RESULTS Eighty-eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9 weeks (IQR 27-34) and mean gestation at delivery was 34.5 weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%. CONCLUSION Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding.
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Affiliation(s)
- Andrew Wang Shen
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alka Kothari
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Anndrea Flint
- Department of Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Sailesh Kumar
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia.,Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.,Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
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Khoury V, Omran A, Taishori N. A rare case of idiopathic intrauterine intestinal volvulus complicated with intestinal perforation: a case report from Syria. J Surg Case Rep 2021; 2021:rjab192. [PMID: 34055287 PMCID: PMC8159198 DOI: 10.1093/jscr/rjab192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Fetal intestinal volvulus is rare, but it is a serious condition due to its life-threatening complications. The bowel loop becomes twisted; thus, impaired venous return leads to bowel necrosis. Prenatal volvulus is most secondary to intestinal atresia, arterial supply defect or without any underlying cause, with consideration that cystic fibrosis is the cause of the intestinal obstruction, because of meconium ileus. We report a case of prenatal volvulus complicated with intestinal perforation and meconium peritonitis in the context of meconium ileus.
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Affiliation(s)
- Victor Khoury
- Pediatric Surgery Department, Tishreen University Hospital, Latakia, Syria
| | - Ammar Omran
- Pediatric Surgery Department, Tishreen University Hospital, Latakia, Syria
| | - Norma Taishori
- Pediatric Department, Tishreen University Hospital, Latakia, Syria
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Shimizu T, Yokomine M, Yoshizato T, Araki K, Higashidate N, Saikusa M, Ushijima K. Difficulty in prenatal diagnosis of the volvulus of the small intestine: A peculiar clinical course of two cases with massive bowel dilatation and loss of peristalsis. J Obstet Gynaecol Res 2021; 47:1903-1908. [PMID: 33590600 DOI: 10.1111/jog.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/27/2022]
Abstract
We report two cases of fetal intestinal volvulus (jejunum in case A, ileum in case B) with massive bowel dilatation and loss of peristalsis, which suddenly appeared in the third trimester. The bowel was dilated to different sizes and there were various echogenic patterns of the intestines in case A and a sausage-like appearance in case B. Case A developed polyhydramnios, whereas case B did not. Among 47 cases of fetal intestinal volvulus (29 articles) in which 32 were diagnosed prenatally, almost all cases with a prenatal diagnosis showed "whirlpool sign" or "coffee bean sign" by sonography and/or findings indicating intestinal hemorrhage. Even without these findings, the presence of dilatation of the intestines and loss of peristalsis occurring in the third trimester were diagnostic clues. The presence of different sizes and various patterns of bowel dilation and hydramnios may be helpful for predicting the involved site of intestinal volvulus.
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Affiliation(s)
- Takahiro Shimizu
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Masato Yokomine
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Kenshiro Araki
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Naruki Higashidate
- Department of Pediatric Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Mamoru Saikusa
- Department of Pediatrics, School of Medicine, Kurume University, Kurume, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
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Neonatal segmental small bowel volvulus with normal intestinal rotation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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7
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Lap CC, Voskuilen CS, Pistorius LR, Mulder EJH, Visser GHA, Manten GTR. Reference curves for the normal fetal small bowel and colon diameters; their usefulness in fetuses with suspected dilated bowel. J Matern Fetal Neonatal Med 2019; 33:633-638. [PMID: 29985072 DOI: 10.1080/14767058.2018.1498837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: To establish reference curves of normal fetal small bowel and colon diameters and to assess the clinical applicability.Method: Serial longitudinal ultrasound examinations at 4-week intervals between 20 to 41 weeks of gestation in 39 low-risk fetuses. The largest loop of the small bowel and colon was identified. The bowel lumen short axis was measured. Linear mixed modeling was used to determine individual developmental trajectories. Twenty-eight fetuses with suspected bowel dilatation were analyzed relative to the reference curves.Results: Development of the small bowel and colon diameters was best described by a linear and cubic model, respectively. The intraobserver and interobserver concordance were >0.94. In cases with suspected bowel dilatation, normal fetal outcome occurred if the bowel dilatation was transient. Progressive increase of fetal bowel diameter was associated with pathology after birth. Cases with small bowel pathology had a z-score >8 after 25 weeks of gestation.Conclusion: We provided the first ultrasound reference curves for normal fetal small bowel and colon diameters. Progressive increase in the fetal bowel diameter z-score was highly predictive of intestinal abnormalities after birth. Longitudinal follow-up of dilated fetal bowel is important to distinguish normality from disease.
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Affiliation(s)
- Chiara C Lap
- Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands
| | - Charlotte S Voskuilen
- Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands
| | - Lourens R Pistorius
- Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, University of Stellenbosch, Stellenbosch, South Africa
| | - Eduard J H Mulder
- Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands
| | - Gwendolyn T R Manten
- Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, Isala Women and Children's Hospital, Zwolle, The Netherlands
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8
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Bartholmot C, Faure JM, Grosjean F, Couture A, Forgues D, Fuchs F, Prodhomme O. Prenatal diagnosis of antenatal midgut volvulus: Specific ultrasound features. Prenat Diagn 2018; 39:16-25. [PMID: 30536936 DOI: 10.1002/pd.5392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/06/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess specific, direct, and indirect prenatal ultrasound features in cases of fetal midgut volvulus. METHODS Retrospective case series of neonatal volvulus, based on postnatal and prenatal imaging findings that occurred from 2006-2017. Prenatal and postnatal signs including the specific "whirlpool sign" were computed. Postnatal volvulus was confirmed by pathology examination after surgery or neonatal autopsy. RESULTS Thirteen cases of midgut volvulus were identified. Though not a specific sign, a decrease in active fetal movements was reported in eight patients (61.5%). The prenatal whirlpool sign was directly seen in 10 cases, while an indirect but suggestive sign, a fluid-filled level within the dilated loops, was present in five cases. No intestinal malrotation was observed. Pregnancy outcomes were two terminations of pregnancy, both associated with cystic fibrosis, one early neonatal death, three prenatal spontaneous regressions, and seven favorable outcomes after neonatal surgery with resection of midgut atresia. CONCLUSIONS Identification of the whirlpool sign or of a fluid-filled level within the dilated loops improves the accuracy of ultrasound findings for suspected volvulus. In the absence of total volvulus (in cases of intestinal malrotation) or association with cystic fibrosis, the prognosis appears good.
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Affiliation(s)
- Caroline Bartholmot
- Department of Obstetrics and Gynecology, CHU Montpellier, Montpellier, France
| | - Jean-Michel Faure
- Department of Obstetrics and Gynecology, CHU Montpellier, Montpellier, France
| | - Frederic Grosjean
- Department of Obstetrics and Gynecology, Nimes University Hospital Center, Nîmes, France
| | - Alain Couture
- Department of Pediatric Imaging, CHU Montpellier, Montpellier, France
| | - Dominique Forgues
- Department of Abdominal and Urologic Surgery, CHU Montpellier, Hôpital Lapeyronie, Montpellier, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, CHU Montpellier, Montpellier, France.,Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
| | - Olivier Prodhomme
- Department of Pediatric Imaging, CHU Montpellier, Montpellier, France
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AL-Osail EM, Alotaibi N, Alghamdi F, Alkhamis M. Primary segmental intestinal volvulus associated with acute appendicitis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Xu S, Zhong W, Shen Z, Dai C, Xia H, Guan Q, Bai L, Yu J. Analysis of the clinical outcomes of fetal bowel dilatation combined with other abnormal ultrasonographic features. J Matern Fetal Neonatal Med 2017; 32:992-996. [DOI: 10.1080/14767058.2017.1397123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Suting Xu
- Department of Gynecological Oncology, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Wei Zhong
- Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Zhuanxing Shen
- Department of Gynecological Oncology, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Changping Dai
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Huimin Xia
- Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Qiansi Guan
- Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Lihua Bai
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Jiakang Yu
- Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China
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Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor. Case Rep Obstet Gynecol 2017; 2017:7642784. [PMID: 29230337 PMCID: PMC5688350 DOI: 10.1155/2017/7642784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022] Open
Abstract
Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome.
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12
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Tonni G, Grisolia G, Granese R, Giacobbe A, Napolitano M, Passos JP, Araujo Júnior E. Prenatal diagnosis of gastric and small bowel atresia: a case series and review of the literature. J Matern Fetal Neonatal Med 2015; 29:2753-61. [PMID: 26465268 DOI: 10.3109/14767058.2015.1107902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Gabriele Tonni
- a Department of Obstetrics & Gynecology , Guastalla Civil Hospital , AUSL Reggio Emilia, Reggio Emilia , Italy
| | - Gianpaolo Grisolia
- b Department of Obstetrics & Gynecology , Hospital "C. Poma", Mantua , Italy
| | - Roberta Granese
- c Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, Università Degli Studi Di Messina , Messina , Italy
| | - Annamaria Giacobbe
- c Department of Pediatric , Gynecological, Microbiological and Biomedical Sciences, Università Degli Studi Di Messina , Messina , Italy
| | - Marcello Napolitano
- d Department of Radiology and Neuroradiology , Istituti Clinici Di Perfezionamento , "V. Buzzi", Milan , Italy , and
| | - Jurandir Piassi Passos
- e Department of Obstetrics , Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Edward Araujo Júnior
- e Department of Obstetrics , Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
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13
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Kim Y, Hwang J, Moon SB. Primary segmental volvulus of the ileum in a fetus: Case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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