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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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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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4
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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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5
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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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6
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Mise N, Terui K, Mitsunaga T, Ohara Y, Hishiki T. Delivery time of two cases of fetal intestinal volvulus. Pediatr Int 2022; 64:e15137. [PMID: 35468244 DOI: 10.1111/ped.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Naoko Mise
- Department of Pediatric Surgery, Matsudo City General Hospital, Chiba, Japan.,Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tetsuya Mitsunaga
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Pediatric Surgery, Chiba Kaihin Municipal Hospital, Chiba, Japan
| | - Yukiko Ohara
- Department of Pediatric Surgery, Matsudo City General Hospital, Chiba, Japan.,Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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7
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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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8
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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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9
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Chen D, Tam KH, Zhang Y, Xiao S, Yang C, Tang X. Prenatal diagnosis of midgut volvulus with jejunal atresia by ultrasonography. J Obstet Gynaecol Res 2020; 46:1203-1206. [PMID: 32452074 DOI: 10.1111/jog.14296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/12/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Dan Chen
- Department of Ultrasound Guangdong Women and Children's Hospital Guangzhou China
| | - Kwong Ho Tam
- Fong Son Tong Health Centre Health Bureau Macau SAR China
| | - Yulan Zhang
- Department of Ultrasound Guangdong Women and Children's Hospital Guangzhou China
| | - Shangjie Xiao
- Department of Neonatal Surgery Guangdong Women and Children's Hospital Guangzhou China
| | - Chaoxiang Yang
- Department of Radiology Guangdong Women and Children's Hospital Guangzhou China
| | - Xuezhen Tang
- Department of Ultrasound Guangdong Women and Children's Hospital Guangzhou China
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10
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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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11
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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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12
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Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound. Case Rep Obstet Gynecol 2018; 2018:5312179. [PMID: 29854513 PMCID: PMC5960549 DOI: 10.1155/2018/5312179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
Background Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis. Case Description We present a case of fetal ileal volvulus suspected on third trimester ultrasound, complicated by premature labour, small bowel necrosis, and meconium peritonitis. Progressive dilatation and decreased peristalsis of echogenic bowel were noted in the early part of the third trimester. Daily surveillance ultrasound was performed and spontaneous labour occurred at 32 weeks' gestation. A proactive postnatal approach guided by prenatal sonographic findings allowed prompt treatment and an urgent laparotomy was performed for an ileal volvulus with necrosis and meconium peritonitis. A segment of small bowel volvulus was resected and an end-to-end anastomosis was performed with uneventful recovery. Discussion Clinically signs of fetal midgut volvulus are not pathognomonic, such as intestinal dilatation, abdominal mass, ascites, peritoneal calcifications, or polyhydramnios; thus, the diagnosis is often challenging. Complications reported in the literature include perforation and haemorrhagic ascites, which may lead to anaemia, hypovolemia, heart failure, and fetal demise. Conclusion This case highlights the importance of assessing the fetal bowel as a part of routine third trimester ultrasound. The case describes the complexity of diagnosis in the fetus, important considerations along with multidisciplinary team approach to management.
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13
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Moore GP, Byrne A, Davila J, Sarfi E, Bettolli M. Worsening anemia associated with volvulus in a stable neonate with intestinal obstruction. J Neonatal Perinatal Med 2018; 11:417-422. [PMID: 30584174 DOI: 10.3233/npm-17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intrauterine intestinal obstruction complicated by midgut volvulus is a serious life-threatening diagnosis. Immediate surgical intervention is generally the course of action upon diagnosis to prevent morbidity and mortality. We report a case of intrauterine intestinal obstruction where the neonate then presented with an unusual onset of volvulus within the first 12 hours of life. The patient was born with generalized edema, a distended abdomen, and pallor. Unlike many cases, the patient did not present with typical signs of volvulus. Diagnostic imaging preceding delivery and the stable postnatal clinical course did not offer a justification for immediate laparotomy. Less than 24 hours later, the patient's hemoglobin significantly dropped leading to an emergent laparotomy. Findings included a volvulus of the terminal ileum and large amounts of intraluminal blood. Our case report includes an analysis of clinical observations that should be considered so that patients presenting with similar signs receive earlier surgical intervention.
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Affiliation(s)
- G P Moore
- Division of Neonatology, Children's Hospital of Eastern Ontario, Canada
- Faculty of Medicine, University of Ottawa, Canada
| | - A Byrne
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Canada
| | - J Davila
- Faculty of Medicine, University of Ottawa, Canada
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Canada
| | - E Sarfi
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Canada
| | - M Bettolli
- Faculty of Medicine, University of Ottawa, Canada
- Department of Surgery, Children's Hospital of Eastern Ontario, Canada
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14
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Khen-Dunlop N, Beaudoin S, Marion B, Rousseau V, Giuseppi A, Nicloux M, Grevent D, Salomon LJ, Aigrain Y, Lapillonne A, Sarnacki S. Segmental volvulus in the neonate: A particular clinical entity. J Pediatr Surg 2017; 52:454-457. [PMID: 28443816 DOI: 10.1016/j.jpedsurg.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Complete intestinal volvulus is mainly related to congenital anomalies of the so-called intestinal malrotation, whereas segmental volvulus appears as a distinct entity, mostly observed during the perinatal period. Because these two situations are still lumped together, the aim of this study was to describe the particular condition of neonatal segmental volvulus. STUDY DESIGN We analyzed the circumstances of diagnosis and management of 17 consecutives neonates operated for segmental volvulus more than a 10-year period in a single institution. During the same period, 19 cases of neonatal complete midgut volvulus were operated. RESULTS Prenatal US exam anomalies were observed in 16/17 (94%) of segmental volvulus, significantly more frequently than in complete volvulus (p=0.003). Intestinal malposition was described peroperatively in all cases of complete volvulus, but also in 4/17 segmental volvulus (23%). Intestinal resection was performed in 88% of segmental volvulus when only one extensive intestinal necrosis was observed in complete volvulus. Parenteral nutrition was required in all patients with segmental volvulus with a median duration of 50days (range 5-251). CONCLUSION Segmental volvulus occurs mainly prenatally and leads to fetal ultrasound anomalies. This situation, despite a limited length of intestinal loss, is associated to significant postnatal morbidity. TYPE OF THE STUDY Treatment study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Naziha Khen-Dunlop
- AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France; Université Paris Descartes, Paris, France; EA 7328 FETUS, Hôpital Necker-Enfants malades, Paris, France.
| | - Sylvie Beaudoin
- AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France; Université Paris Descartes, Paris, France
| | - Blandine Marion
- AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France
| | - Véronique Rousseau
- AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France
| | - Agnes Giuseppi
- AP-HP, Hôpital Necker-Enfants malades, Service de Néonatalogie, Paris, France
| | - Muriel Nicloux
- AP-HP, Hôpital Necker-Enfants malades, Service de Néonatalogie, Paris, France
| | - David Grevent
- AP-HP, Hôpital Necker-Enfants malades, Service de Radiologie Pédiatrique, Paris, France
| | - Laurent J Salomon
- AP-HP, Hôpital Necker-Enfants malades, Maternité, Paris, France; Université Paris Descartes, Paris, France; EA 7328 FETUS, Hôpital Necker-Enfants malades, Paris, France
| | - Yves Aigrain
- AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France; Université Paris Descartes, Paris, France
| | - Alexandre Lapillonne
- AP-HP, Hôpital Necker-Enfants malades, Service de Néonatalogie, Paris, France; Université Paris Descartes, Paris, France
| | - Sabine Sarnacki
- AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France; Université Paris Descartes, Paris, France
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15
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Başaran A, Başaran M. What is your diagnosis? J Turk Ger Gynecol Assoc 2016; 17:123-5. [PMID: 27403081 DOI: 10.5152/jtgga.2016.16036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ahmet Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Mustafa Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
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16
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Fetal Midgut Volvulus with a Cystic Appearance, Accompanying a Sinus Rhythm and an Increased Peak Systolic Velocity without Anemia. Case Rep Obstet Gynecol 2016; 2015:354619. [PMID: 26779358 PMCID: PMC4686707 DOI: 10.1155/2015/354619] [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: 09/05/2015] [Revised: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022] Open
Abstract
A midgut volvulus rarely occurs in a fetus; however, when it does, it requires an immediate diagnosis and surgery. Thirty-week pregnant was referred to our clinic with a diagnosis of a fetal abdominal cystic mass and preterm labor. The initial ultrasound examination revealed a female fetus with a 55 × 50 mm cystic mass in the lower abdomen, which was preliminarily diagnosed as an ovarian cyst. There was a sinusoidal rhythm on cardiography. The middle cerebral artery peak systolic velocity was 60.4 cm/sec, compatible with 1.49 MoMs that suggested fetal anemia on Doppler examination. Uterine contractions were observed with tocography and maternal hydration was administered for tocolytic treatment. Despite hydration, uterine contractions continued and the infant was delivered. A newborn ultrasonographic evaluation revealed a 6 cm abdominal cyst, and plain abdominal radiographs revealed distended loops of the small bowel on the left side. Emergency surgery was performed. A midgut volvulus leading to dilatation and necrosis of the small bowel without anatomical causes was observed during laparotomy. The necrotic bowel loop was resected and an end-to-end anastomosis was performed. The newborn died due to multiorgan failure. Obstetricians should be familiar with the appropriate diagnosis and management of a fetal volvulus.
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17
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Sciarrone A, Teruzzi E, Pertusio A, Bastonero S, Errante G, Todros T, Viora E. Fetal midgut volvulus: report of eight cases. J Matern Fetal Neonatal Med 2015; 29:1322-7. [PMID: 26103780 DOI: 10.3109/14767058.2015.1047336] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate whether prenatal diagnosis of intestinal midgut volvulus (a rare condition due to the small bowel loops twisting) can improve the prognosis of the newborns. METHODS In our Prenatal Diagnosis Center, eight cases of intestinal volvulus observed between 2007 and 2014 were retrospectively considered. Ultrasonographic signs can be direct and specific (whirlpool sign, coffee bean sign) or indirect and non-specific (abdominal mass, dilated bowel loops, pseudocysts, ascites, polyhydramnios). RESULTS Prenatal diagnosis was performed at 20-34 weeks of gestation. All newborns were exposed to an emergency surgery: the major complication was due to cystic fibrosis. CONCLUSIONS An early suspicion of intestinal volvulus allows the clinician to refer the patient to a tertiary center so to confirm the diagnosis and perform an appropriate follow-up in order to identify the proper time of delivery. The prognosis of the babies with prenatal intestinal volvulus depends on the length of the segment involved, on the level of intestinal obstruction, on the presence of meconium peritonitis and on the gestational age at birth. Our experience, according with the literature, suggests that ascites and absence of abdominal peristalsis are ultrasonographic signs that, in the third trimester of pregnancy, correctly lead to an immediate delivery intervention.
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Affiliation(s)
- A Sciarrone
- a Ultrasound and Prenatal Diagnosis Unit, Department of Gynecology and Obstetrics , AOU Città della Salute e della Scienza , Turin , Italy and
| | - E Teruzzi
- b Pediatric Surgery Unit, Department of Pediatric Sciences , AOU Città della Salute e della Scienza , Turin , Italy
| | - A Pertusio
- a Ultrasound and Prenatal Diagnosis Unit, Department of Gynecology and Obstetrics , AOU Città della Salute e della Scienza , Turin , Italy and
| | - S Bastonero
- a Ultrasound and Prenatal Diagnosis Unit, Department of Gynecology and Obstetrics , AOU Città della Salute e della Scienza , Turin , Italy and
| | - G Errante
- a Ultrasound and Prenatal Diagnosis Unit, Department of Gynecology and Obstetrics , AOU Città della Salute e della Scienza , Turin , Italy and
| | - T Todros
- a Ultrasound and Prenatal Diagnosis Unit, Department of Gynecology and Obstetrics , AOU Città della Salute e della Scienza , Turin , Italy and
| | - E Viora
- a Ultrasound and Prenatal Diagnosis Unit, Department of Gynecology and Obstetrics , AOU Città della Salute e della Scienza , Turin , Italy and
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18
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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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19
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Nakagawa T, Tachibana D, Kitada K, Kurihara Y, Terada H, Koyama M, Sakae Y, Morotomi Y, Nomura S, Saito M. A case of fetal intestinal volvulus without malrotation causing severe anemia. JAPANESE CLINICAL MEDICINE 2015; 6:1-3. [PMID: 25628516 PMCID: PMC4285054 DOI: 10.4137/jcm.s20760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 11/05/2022]
Abstract
Fetal intestinal volvulus without malrotation is a rare, life-threatening disease. Left untreated, hemorrhage from necrotic bowel tissue will lead to severe fetal anemia and even intrauterine death. We encountered a case of fetal intestinal volvulus causing severe anemia, which was diagnosed postnatally and successfully treated with surgical intervention.
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Affiliation(s)
- Tomoko Nakagawa
- Department of Obstetrics and Gynecology, Sumiyoshi Municipal Hospital, Higashikagaya, Sumiyoe, Osaka, Japan
| | - Daisuke Tachibana
- Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Kohei Kitada
- Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Yasushi Kurihara
- Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Hiroyuki Terada
- Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Masayasu Koyama
- Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Yukari Sakae
- Pediatric Surgery, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Yoshiki Morotomi
- Pediatric Surgery, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Shiho Nomura
- Pediatrics, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
| | - Mika Saito
- Pediatrics, Osaka City University Graduate School of Medicine, Asahimachi Abeno, Osaka, Japan
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20
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Prenatal diagnosis and management of an intestinal volvulus with meconium ileus and peritonitis. Arch Gynecol Obstet 2014; 290:385-7. [PMID: 24682585 DOI: 10.1007/s00404-014-3223-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Fetal intestinal volvulus is a rare but serious finding with a high risk of potential life threatening fetal complications. Delay in diagnosis or treatment can increase mortality and morbidity. We report a case of mild fetal bowel dilatation at 30 weeks of gestation and intestinal volvulus presented by the 'whirl-sign', intestinal perforation and meconium peritonitis with fetal ascites and polyhydramnios at 33 weeks of gestation. This case emphasizes the role of examination of the bowel in third trimester ultrasound and the importance of quick decision to delivery and interdisciplinary perinatal management at suspected fetal volvulus with bowel necrosis and intraabdominal bleeding.
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21
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Tan RMR, Lee J, Biswas A, Amutha C. Ascites, anemia and (intestinal) atresia. J Perinatol 2014; 34:78-80. [PMID: 24374868 DOI: 10.1038/jp.2013.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/06/2013] [Accepted: 08/26/2013] [Indexed: 11/09/2022]
Abstract
We report a neonate who presented antenatally with fetal ascites and fetal anemia. The cause of this remained uncertain until 2 weeks later when bowel dilatation was noted on antenatal ultrasound. Clinical signs of intestinal obstruction became evident after delivery, and ileal atresia was found at laparotomy, which was resected with primary anastomosis. Recent reports in the literature have suggested a possible connection between fetal ascites, anemia and dilated bowel with neonatal intestinal obstruction. In these cases and ours, the likely sequence of events was that of in utero midgut volvulus with bleeding into ischemic bowel, hemorrhagic ascites resulting in fetal anemia and progressive bowel dilatation occurring as a consequence of intestinal atresia. Early treatment in our patient with intrauterine blood transfusion may have altered the natural history of her condition, allowing pregnancy to progress to term with a subsequent improved outcome.
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Affiliation(s)
- R M R Tan
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - J Lee
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - A Biswas
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - C Amutha
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
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22
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Ludwiczek J, Lechner E, Preuer-Lackner B, Kargl S, Pumberger W. Intrauteriner segmentaler Volvulus der „Midgut“-Schleife. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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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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24
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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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25
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Yu W, Ailu C, Bing W. Sonographic diagnosis of fetal intestinal volvulus with ileal atresia: a case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:255-7. [PMID: 22585388 DOI: 10.1002/jcu.21896] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/09/2012] [Indexed: 05/10/2023]
Abstract
Fetal intestinal volvulus is a rare life-threatening condition usually manifesting after birth with most cases being associated with intestinal malrotation. It appears on prenatal sonography (US) as a twisting of the bowel loops around the mesenteric artery, leading to mechanical obstruction and ischemic necrosis of the bowel. We report a case of intrauterine intestinal volvulus with ileal atresia, suspected when US revealed a typical "whirlpool" sign at 37 weeks' gestation, with a segment of markedly distended bowel loops and small amount of fetal ascites.
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Affiliation(s)
- Wang Yu
- Department of Ultrasonography, Shengjing Hospital of China Medical University, Sanhao, Street 36, Heping District, Shenyang City, Liaoning Province, 110004, China
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27
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Abstract
The pediatric population has a number of unique considerations related to the diagnosis and treatment of ascites. This review summarizes the physiologic mechanisms for cirrhotic and noncirrhotic ascites and provides a comprehensive list of reported etiologies stratified by the patient's age. Characteristic findings on physical examination, diagnostic imaging, and abdominal paracentesis are also reviewed, with particular attention to those aspects that are unique to children. Medical and surgical treatments of ascites are discussed. Both prompt diagnosis and appropriate management of ascites are required to avoid associated morbidity and mortality.
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