Infarcted intestinal volvulus detected by prenatal ultrasonography

Hasegawa, Toshimichi; Yoshioka, Yasuhiro; Sasaki, Takashi; Iwasaki, Yasuhiro; Miki, Yasuaki; Sumimura, Junichi; Tomimatsu, Takuji; Shimizu, Kazuki; Ban, Hiroshi; Dezawa, T

doi:10.1007/bf00180094

Cited by 5 publications

(27 citation statements)

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“…Accordingly, there was no index of suspicion for the presence of malrotation or midgut volvulus, and an UGI contrast study had never been performed. There have been reported cases of fetal malrotation being discovered on prenatal ultrasound by the demonstration of the ‘whirlpool sign,’ polyhydramnios and abnormal Doppler flow studies (among other signs) 11–13. Some of these same studies also state, however, that the sonographic findings of volvulus are usually apparent after 27 weeks of pregnancy 11.…”

Section: Discussionmentioning

confidence: 99%

Intestinal malrotation in an extremely preterm very low birthweight infant

Costner

Carter²,

Wentz³

et al. 2011

Case Reports

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SummaryA 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. Consultation with the Pediatric Surgery was sought and, on arrival at the bedside, the surgeon placed a Penrose drain in the right lower quadrant of the abdomen. Foul smelling gas escaped through the surgical wound and feculent, bloody material drained from the site. Ventilation improved after the drain was placed and the abdomen decompressed, but the infant remained gravely ill. BMJ Case Reports OUTCOME AND FOLLOW-UPDespite all efforts, the infant's acidaemia and coagulopathy continued. Florid pulmonary haemorrhage ensued and she became bradycardic. After counselling the family, life support was withdrawn. The time from initial grossly bloody stool to death was 12 h. A premortem blood culture and a peritoneal swab at the time of abdominal decompression and Penrose drain placement grew Enterobacter sakazakii within 24 h.An autopsy examination using the standard Rokitansky evisceration method was performed. There was incomplete intestinal rotation with Ladd's bands at the third portion of the duodenum and caecum in midabdomen ( fi gure 2 ). Histologically, there were massively dilated lymphatics, veins and arteries within the small bowel submucosa consistent with gross fi ndings of incomplete rotation and midgut volvulus. Of a total of 161 cm of bowel, approximately 75% demonstrated necrosis with the exception of the proximal duodenum and distal rectum.Histologically, there was extensive transmural ischaemic necrosis but no evidence of perforation. Additional fi ndings included bilateral haemorrhagic adrenal glands (Waterhouse-Friderichsen syndrome; fi gure 3 ). Postmortem blood cultures were positive for E sakazakii . DISCUSSIONThe classic description of intestinal malrotation is that of the term infant who presents with bilious emesis and then has the diagnosis confi rmed with an upper gastrointestinal contrast study (UGI) that demonstrates the right-sided position of the duodenal-jejunal junction or evidence of a midgut volvulus. 4 There exists a number of case reports of this phenomenon in term infants, but the fi nding has rarely been described in the very low birthweight (VLBW) preterm infant. 5 6 Intestinal malrotation occurs in approximately 1% of the general population. During fetal development, midgut rotation is a multistep process requiring herniation of the intestinal contents, rotation 270° around the superior mesenteric artery and return to the abdominal cavity. Nonrotation, malrotation, reverse rotation and incomplete rotation are variations of this phenomenon. With malrotation, the gut has 'fl oppy' attachments and can lose its blood supply through torsion or restrictive Ladd's bands. Midgut volvulus and ischaemia can occur at any age with no apparent warning or trigger, but often presents in the pediatric population. The typical early symptoms are irritability, poor feeding and bilious emesis, which ar...

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Section: Discussionmentioning

confidence: 99%

Intestinal malrotation in an extremely preterm very low birthweight infant

Costner

Carter²,

Wentz³

et al. 2011

Case Reports

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“…Gestation at delivery was recorded for 77 (87.5%) cases 2–6,8,9,11,12,14–21,24–27,29–35,43–59,63–68 with a mean gestation at birth of 34.5 weeks (SD 2.8). The rate of preterm birth under 37 weeks gestation was high (61/77, 79.2%).…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 61/77 (79.2%) infants 3–6,8,9,11,12,14,15,18–21,24,26,27,29–31,33–35,42–52,54–59,63,64 were delivered before 37 completed weeks gestation. Gestation at diagnosis was reported in 80 (90.9%) cases 2–7,9,11–22,24–27,29,30,32–35,42–63,65 with a median gestation of 31.9 weeks (IQR 27–34)—in 32 of these cases 2,4,5,11,14,16,17,24–27,30,31,34,35,42,43,45–49,51,52,56–58 ultrasound findings precipitated iatrogenic delivery at a mean gestation of 34.2 weeks (SD 2.3). In 72 (81.8%) cases, 2–6,9,11,12,14–20,22,24–27,29–35,42,43,45–49,51–59,63–68 the mode of birth was reported.…”

Section: Resultsmentioning

confidence: 99%

“…In 72 (81.8%) cases, 2–6,9,11,12,14–20,22,24–27,29–35,42,43,45–49,51–59,63–68 the mode of birth was reported. Of these, 48/72 (66.7%) infants 2,4–6,11,14–17,20,25,27,30,31,34,35,42,45–49,51–54,56–58,64–68 were delivered by caesarean section.…”

Section: Resultsmentioning

confidence: 99%

“…In all cases of multiple pregnancy only one twin was affected. Birth weight was reported for 61 infants 2,3,5–9,11,12,14,16,18–22,24–27,29–35,42,43,45–49,51–54,57–59,63–68 —the mean birthweight was 2400.2 g (SD 628.4). Of these, 11/61 (18.0%) 16,19,24,46–48,51,53,57 were classified as SGA.…”

Section: Resultsmentioning

confidence: 99%

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Prenatal imaging features and perinatal outcomes of foetal volvulus–A literature review

et al. 2022

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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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