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Acer-Demir T, Şahin-Uysal N. Intrauterine volvulus: systemic review of the literature with pooled analysis. J Perinatol 2024:10.1038/s41372-024-01984-6. [PMID: 38704480 DOI: 10.1038/s41372-024-01984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Our objective is to analyse the observations related to intrauterine volvulus and assess how clinical manifestations and treatment strategies impact prognosis. We conducted a comprehensive search on Pubmed and ClinicalTrials.gov from inception to July 2022, using search terms like "intrauterine volvulus" or "foetal volvulus," supplemented by manual scrutiny of reference lists in relevant texts and articles. Our review encompassed 57 case reports/case series, involving 88 cases. The presence of foetal bradycardia during prenatal visits (p = 0.002) and the existence of meconium cyst or pseudocyst (p = 0.038) significantly influence survival rates. Preterm labour occurred more frequently among cases resulting in mortality (54% vs 21%; p = 0.055). Our study's limitations include the inability to access all reported cases and reliance solely on available data. We advocate for vigilant monitoring of foetuses exhibiting signs of intestinal obstruction, and consideration of an emergent caesarean section as a pre-emptive measure before foetal biophysical profile deterioration worsens.
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Affiliation(s)
- Tuğba Acer-Demir
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey.
| | - Nihal Şahin-Uysal
- Department of Obstetrics and Gynaecology, Başkent University, Faculty of Medicine, Ankara, Turkey
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2
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Yang TY, Chen WC. Intrauterine Volvulus: A Case Report. Cureus 2023; 15:e47712. [PMID: 38021592 PMCID: PMC10676236 DOI: 10.7759/cureus.47712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Intrauterine volvulus is an extremely rare disorder. Its diagnosis is difficult to make antenatally, unless typical pictures are obtained. Owing to its high morbidity and mortality, intensive monitoring of the fetal condition is mandatory. Here, we report a patient, gravida 4, para 1 (G4P1), who had suffered from preterm labor and diminishing fetal movement and was brought to the emergency unit after her 35th week of pregnancy. Ultrasonography was performed to reveal a fetus with a markedly distended bowel (18 mm in width). Intestinal obstruction related to intrauterine volvulus was highly suspected. The fetus was delivered via Cesarean section because of its deteriorated abdominal condition. Urgent exploratory laparotomy was done by a pediatric surgeon to relieve the bowel obstruction on the second day after birth, on the account of poor improvement of the newborn. The newborn did well after segmental resection and was subsequently followed up at the pediatric outpatient clinic. In conclusion, early detection, intensive monitoring, prompt delivery, and urgent surgical intervention are the key to save the fetal life and neonatal health.
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Affiliation(s)
- Tzu-Yao Yang
- Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, TWN
| | - Wei-Chih Chen
- Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, TWN
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3
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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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4
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Occult Antenatal Fetal Abdominal Emergencies Resulting in Unplanned Preterm Delivery. Indian J Pediatr 2022; 89:1010-1012. [PMID: 35119646 DOI: 10.1007/s12098-022-04091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022]
Abstract
Acute abdomen in the fetus can present as nonspecific fetal distress, and occasionally necessitate emergency cesarean section for the mother and subsequent emergency neonatal surgery. Often, preoperative diagnosis in utero is challenging. The authors herein report two cases, a case of primary segmental antenatal intestinal volvulus resulting in the mother presenting at 35 wk with symptoms and decreased fetal movements, and another case of a rapidly distending fetal abdominal mass at 31 wk manifesting as fetal hydrops. The postdelivery newborn management issues are presented. Early identification by the maternal and neonatal team allows for early neonatal surgery and can reduce morbidity and mortality. This can be facilitated by advanced maternal and child health services and efficient patient transport systems.
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5
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Chen J, Wu D. Prenatal diagnosis of fetal midgut volvulus: a case description. Quant Imaging Med Surg 2022; 12:4326-4330. [PMID: 35919058 PMCID: PMC9338359 DOI: 10.21037/qims-22-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Junjun Chen
- Department of Ultrasound Diagnosis, The Second Affiliated Hospital and Yuying Hospital of Wenzhou Medical University, Wenzhou, China
| | - Daozhu Wu
- Department of Ultrasound Diagnosis, The Second Affiliated Hospital and Yuying Hospital of Wenzhou Medical University, Wenzhou, China
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Green T, Chen D, Mishael T, Shen O. A unique sonographic presentation of prenatal volvulus associated with malrotation. Clin Case Rep 2021; 9:e04525. [PMID: 34257993 PMCID: PMC8259922 DOI: 10.1002/ccr3.4525] [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] [Received: 02/02/2021] [Revised: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
This is a unique case of prenatal diagnosis of bowel malrotation suspected by an abnormal course of the duodenum. Early detection of volvulus was enabled, leading to timely intervention and a favorable outcome.
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Affiliation(s)
- Tamar Green
- Department of Obstetrics and GynecologyFaculty of MedicineShaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
| | - Daniela Chen
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Tali Mishael
- Department of Obstetrics and GynecologyFaculty of MedicineShaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
| | - Ori Shen
- Department of Obstetrics and GynecologyFaculty of MedicineShaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
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Pal K, Zayed LH, Khalid YM. Intrauterine intestinal volvulus prompting emergency delivery and surgery in a 32wk fetus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Sonographic diagnosis of isolated fetal ascites due to meconium peritonitis – case report and literature review. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.23.1.2019.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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9
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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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10
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Zahradnikova P, Vidiscak M, Fedorova L, Lindak M, Pavlik S, Sykora L, Trnka J, Babala J. Mesenteric cyst causing intestinal volvulus in a newborn. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Leopold S, Al-Qaraghouli M, Hussain N, Finck C. Magnetic Resonance Imaging Diagnosis of Volvulus through Mesenteric Defect in Neonate. AJP Rep 2016; 6:e239-42. [PMID: 27551577 PMCID: PMC4983723 DOI: 10.1055/s-0036-1584548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Antenatal midgut volvulus is a rare surgical emergency in which bowel is severely compromised. Rarely the etiology is a mesenteric defect. Early diagnosis is essential and lifesaving in the immediate newborn period. Typically upper gastrointestinal or ultrasound imaging can be suggestive of the diagnosis of volvulus in the neonate. Sometimes, however, the diagnosis may be elusive. Herein, we report on the use of neonatal magnetic resonance imaging to diagnose a midgut volvulus that occurred through a congenital mesenteric defect.
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Affiliation(s)
- Scott Leopold
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Mohammed Al-Qaraghouli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
| | - Naveed Hussain
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Christine Finck
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
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12
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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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13
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Ohuoba E, Fruhman G, Olutoye O, Zacharias N. Perinatal survival of a fetus with intestinal volvulus and intussusception: a case report and review of the literature. AJP Rep 2013; 3:107-12. [PMID: 24147247 PMCID: PMC3799706 DOI: 10.1055/s-0033-1349367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/05/2013] [Indexed: 01/11/2023] Open
Abstract
Fetal intestinal volvulus is a rare life-threatening condition. Late diagnosis of volvulus contributes to high rate of morbidity and mortality. It has variable degrees of presentation and survival. Intrauterine volvulus may be complicated by intestinal atresia due to ischemic necrosis. To our knowledge, there are three reported cases of term fetal demise. We report a case of fetal intestinal volvulus with perinatal survival of the largest term infant described with this complication to date. The volvulus was associated with type 3A jejunal atresia and intestinal pathology was noted on prenatal ultrasound. The infant was born via urgent cesarean delivery at 37(6/7) weeks of gestation and underwent emergent exploratory laparotomy with resection of small bowel and primary end-to-end anastomosis. Intrauterine intestinal volvulus may be suspected on prenatal ultrasound but only definitively diagnosed postnatally. Signs of fetal distress and volvulus are rarely associated with reports of survival in the term fetus. We review reported cases of prenatally suspected volvulus in infants documented to survive past the neonatal period. As fetal volvulus and most intestinal atresias/stenoses manifest during the third trimester, we recommend that the limited fetal anatomical survey during growth ultrasounds at 32 to 36 weeks routinely include an assessment of the fetal bowel.
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Affiliation(s)
- Esohe Ohuoba
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas ; Esohe Ohuoba and Gary Fruhman contributed equally to this manuscript
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14
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Fetal primary small bowel volvulus in a child without intestinal malrotation. J Pediatr Surg 2013; 48:e1-5. [PMID: 23895987 DOI: 10.1016/j.jpedsurg.2013.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/20/2022]
Abstract
Fetal primary small bowel volvulus without atresia or malrotation is an extremely rare but life-threatening surgical emergency. We report a case of primary small bowel volvulus that presented as sudden fetal distress and was diagnosed on the basis of the 'whirl-pool sign' of fetal sonography. This diagnosis led to emergency operation after birth at the third trimester with a good outcome. Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology.
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15
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Cho EH, Sung SI, Yoo HS, Ahn SY, Yoo SY, Chang YS, Seo JM, Park WS. Intrauterine Midgut Volvulus with Malrotation in a Preterm Infant: A Case Report. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.4.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Eun Hyun Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Soo Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Yoo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Meen Seo
- Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Raherison R, Grosos C, Lemale J, Blondiaux E, Sabourdin N, Dahan S, Rosenblatt J, Guilbert J, Jouannic JM, Mitanchez D, Audry G, Auber F. Volvulus prénatal du grêle : risque vital immédiat mais bon pronostic à long terme. Arch Pediatr 2012; 19:361-7. [DOI: 10.1016/j.arcped.2012.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/13/2011] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
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17
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Costner BJ, Carter BS, Wentz SC, Wills ML. Intestinal malrotation in an extremely preterm very low birthweight infant. BMJ Case Rep 2011; 2011:2011/apr19_1/bcr0620103073. [PMID: 22696631 DOI: 10.1136/bcr.06.2010.3073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case of a very low birthweight premature infant with a clinical presentation of necrotising enterocolitis that was found to have malrotation and midgut volvulus at autopsy is presented.
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Affiliation(s)
- Brian J Costner
- Department of Pediatric/Neonatology, Vanderbilt, Nashville, Tennessee, USA
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18
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Abstract
BACKGROUND Meconium peritonitis (MP) develops when bowel perforation occurs in utero or soon after birth, resulting in leakage of meconium into the peritoneal cavity. The clinical features are often variable and prenatal ultrasonography plays an important role in prenatal diagnosis. METHODS We conducted a retrospective review of neonates diagnosed with MP in our hospital from January 1998 to December 2007. Prenatal examinations, postnatal presentations, investigations, management, patient outcomes, and possible causes were analyzed. RESULTS Ten patients (five boys, five girls) diagnosed with MP were studied. The most common prenatal ultrasonographic finding was fetal ascites (7/10, 70%), followed by polyhydramnios (3/10, 30%), bowel dilatation (3/10, 30%), intra-abdominal calcification (1/10, 10%), and hydrops fetalis (1/10, 10%). Two of our patients were completely normal on prenatal ultrasonography. Only one MP diagnosis (1/10, 10%) was definitely confirmed by prenatal ultrasonography due to the presence of ascites, bowel perforation and intra-abdominal calcification. Nine patients (90%) required surgical intervention because of bowel perforation (5), bowel atresia (2), obstruction due to ileus (1), and intussusception (1). Peritonitis was of cystic type in one case (10%), fibroadhesive in five cases (50%), and generalized in four cases (40%). All 10 patients survived without long-term gastrointestinal complications. CONCLUSION Prenatal ultrasonography can be diagnostic for MP, which should be considered in the differential diagnosis of patients presenting with ascites or abdominal distension at birth. Close observation of postnatal clinical manifestations and timely surgical intervention resulted in a high survival rate and favorable outcome in these patients at our hospital.
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19
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Durand M, Coste K, Martin A, Scheye T, Creveaux I, Vanlieferinghen P, Laurichesse-Delmas H, Dechelotte PJ, Labbe A, Jacquetin B, Lemery D, Gallot D. Fetal midgut volvulus as a sign for cystic fibrosis. Prenat Diagn 2009; 28:973-4. [PMID: 18792923 DOI: 10.1002/pd.2086] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Durand
- Maternal Fetal Medicine Unit, CHU Maternité de l'Hôtel-Dieu, Boulevard Léon Malfreyt, Clermont-Ferrand cédex, France
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20
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Sammour RN, Leibovitz Z, Degani S, Shapiro I, Ohel G. Prenatal diagnosis of small-bowel volvulus using 3-dimensional Doppler sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1655-1661. [PMID: 18946108 DOI: 10.7863/jum.2008.27.11.1655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Rami N Sammour
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
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21
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Park JS, Cha SJ, Kim BG, Kim YS, Choi YS, Chang IT, Kim GJ, Lee WS, Kim GH. Intrauterine midgut volvulus without malrotation: Diagnosis from the ‘coffee bean sign’. World J Gastroenterol 2008; 14:1456-8. [PMID: 18322966 PMCID: PMC2693700 DOI: 10.3748/wjg.14.1456] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fetal midgut volvulus is quite rare, and most cases are associated with abnormalities of intestinal rotation or fixation. We report a case of midgut volvulus without malrotation, associated with a meconium pellet, during the gestation period. This 2.79 kg, 33-wk infant was born via a spontaneous vaginal delivery caused by preterm labor. Prenatal ultrasound showed dilated bowel loops with the appearance of a ‘coffee bean sign’. This patient had an unusual presentation with a distended abdomen showing skin discoloration. An emergency laparotomy revealed a midgut volvulus and a twisted small bowel, caused by complicated meconium ileus. Such nonspecific prenatal radiological signs and a low index of suspicion of a volvulus during gestation might delay appropriate surgical management and result in ischemic necrosis of the bowel. Preterm labor, specific prenatal sonographic findings (for example, the coffee bean sign) and bluish discoloration of the abdominal wall could suggest intrauterine midgut volvulus requiring prompt surgical intervention.
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22
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Steffensen TS, Gilbert-Barness E, DeStefano KA, Kontopoulos EV. Midgut volvulus causing fetal demise in utero. Fetal Pediatr Pathol 2008; 27:223-31. [PMID: 18800265 DOI: 10.1080/15513810802319608] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intestinal malrotation has an incidence of 1 per 6000 live births. The most serious consequence of malrotation is volvulus. Midgut volvulus is a rare condition in which the small bowel and proximal colon twist around the superior mesenteric artery, leading to a high-grade proximal bowel obstruction and vascular compromise of the intestine, thereby leading to infarction of the involved intestine. Midgut volvulus rarely occurs antenatally and is usually not lethal in utero. There are only 7 cases of intrauterine fetal demise caused by midgut volvulus reported in the literature. We report a case of intrauterine fetal demise at 38 weeks of gestation, due to cardiovascular failure and shock from midgut volvulus. Non-specific abnormalities, including ascites and dilated bowel, had been seen on the antenatal ultrasound from the 15th week of gestation. In addition to the volvulus, the fetus had intestinal atresia and arthrogryposis.
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Affiliation(s)
- Thora S Steffensen
- Department of Pathology, University of South Florida, Tampa General Hospital, Tampa, Florida 33606, USA
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Abstract
Fetal death is not commonly associated with cystic fibrosis (CF). We report a case of late intrauterine death attributed to cardiovascular failure and shock consequent to malrotation and intestinal volvulus in a fetus affected with CF. An argument is made that CF promoted this deleterious incident. Whole blood or cell-rich tissue specimens should be preserved and genetic testing for CF considered in stillbirths with intestinal complications.
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Affiliation(s)
- D Trachsel
- Division of Pediatric Intensive Care and Pulmonology, University Children's Hospital Basel, Basel, Switzerland.
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Molvarec A, Bábinszki A, Kovács K, Tóth F, Szalay J. Intrauterine intestinal obstruction due to fetal midgut volvulus: a report of two cases. Fetal Diagn Ther 2006; 22:38-40. [PMID: 17003554 DOI: 10.1159/000095841] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 03/13/2006] [Indexed: 11/19/2022]
Abstract
Fetal midgut volvulus is quite rare, and few surviving infants--particularly cases with meconium peritonitis--have been reported in the literature. We report two cases of intrauterine intestinal obstruction due to fetal midgut volvulus associated with intestinal malrotation. In both cases, the infant survived after cesarean section delivery and appropriate surgical intervention, and they both continue to be in good overall condition. We discuss the prenatal signs and outcome of in utero intestinal volvulus. Close prenatal follow-up and appropriate timing of delivery in cases where ultrasound examination shows signs of fetal intestinal obstruction, as well as optimal postnatal treatment, are essential to reduce the morbidity and mortality associated with fetal midgut volvulus.
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Affiliation(s)
- Attila Molvarec
- Department of Obstetrics and Gynecology, Kútvolgyi Clinical Center, Semmelweis University Faculty of Medicine, Budapest, Hungary.
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Kuroda T, Kitano Y, Honna T, Sago H, Hayashi S, Saeki M. Prenatal diagnosis and management of abdominal diseases in pediatric surgery. J Pediatr Surg 2004; 39:1819-22. [PMID: 15616940 DOI: 10.1016/j.jpedsurg.2004.08.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the prenatal courses and management of abdominal surgical diseases. METHODS Of the 327 patients registered with our fetal treatment board since March 2002, 83 fetuses referred to the surgical department were enrolled for the current study. The prenatal diagnosis, sequential fetal images, and perinatal courses of these cases were reviewed retrospectively. RESULTS Of the 83 cases, abdominal diseases were suspected in 34, lung and thoracic diseases in 25, genitourinary diseases in 12, and other anomalies in 12. Meconium peritonitis (MP), intestinal obstruction, and abdominal wall defects accounted for approximately 65% of the abdominal diseases. Five patients with prenatally diagnosed lung diseases underwent fetal surgical intervention, and 17 of the 22 liveborn patients survived. In contrast, none of the patients with prenatally diagnosed abdominal anomalies underwent fetal surgical intervention, yet, 23 of the 24 liveborn patients survived. However, preterm labor and hydrops were seen frequently in the patients with giant cystic MP, suggesting a fetal critical condition. CONCLUSIONS Although the clinical outcome of abdominal diseases seemed favorable with postnatal treatment, the current results suggested the occurrence of hidden mortality in utero and the potential need for fetal intervention for some abdominal conditions, such as MP.
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Affiliation(s)
- Tatsuo Kuroda
- Department of Surgery, National Center for Child Health and Development, Tokyo, Japan
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Abstract
Caring for children of adolescent parents presents unique challenges. Because adolescent parents may lack parenting skills and knowledge of medical terminology, symptoms of life-threatening illnesses may be misinterpreted. We present two cases of unexpected acute abdomen in young infants with adolescent mothers. The first case involves midgut volvulus, which was discovered during a routine newborn visit. The second case, involving pyloric stenosis, presented a clinical management challenge when the adolescent mother refused diagnostic studies.
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Affiliation(s)
- C J Davis
- Division of General Pediatrics, Children's Hospital Boston, Massachusetts 02115, USA.
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27
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Uerpairojkit B, Charoenvidhya D, Tanawattanacharoen S, Manotaya S, Wacharaprechanont T, Tannirandorn Y. Fetal intestinal volvulus: a clinico-sonographic finding. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:186-187. [PMID: 11530005 DOI: 10.1046/j.1469-0705.2001.00425.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- B Uerpairojkit
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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