Perinatal Survival of a Fetus with Intestinal Volvulus and Intussusception: A Case Report and Review of the Literature

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 376/7 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.

Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis

“…Volvulus is usually a postnatal complication of GS that may cause intestinal atresia due to mechanical obstruction and ischemic necrosis of the bowel [42]. In our cohort study, 4 volvulus cases were detected antenatally and confirmed at birth, of whom 3 died after birth.…”

Magnetic Resonance Imaging Diagnosis of Volvulus through Mesenteric Defect in Neonate

“…Infant was delivered by cesarean section for repetitive late decelerations, and preoperative diagnosis was made by upper GI series with contrast but no MRI was done. 20 Immediate surgical management of these cases is life saving and delay in diagnosis can be fatal. Preterm delivery and surgical intervention should be considered when the diagnosis is made prenatally.…”

Intestinal volvulus in the pump twin of a twin reversed arterial perfusion (TRAP) sequence after laser therapy at 18 weeks: a case report

“…Intestinal volvulus is a rare condition in which the small bowel and proximal colon twist around the superior mesenteric artery. This occurs when the intestinal loop that is suspended along the free margin of the mesentery twists around the anterior mesentery artery [ 8 – 10 ]. Between the eighth and tenth weeks of gestation, malrotation of the fetal gut occurs when the elongating intestine returns to the abdominal cavity.…”

“…Between the eighth and tenth weeks of gestation, malrotation of the fetal gut occurs when the elongating intestine returns to the abdominal cavity. Between the sixth and tenth weeks, the midgut loop rotates 90 degrees counterclockwise around the axis of the superior mesenteric artery [ 8 – 10 ]. This brings the duodenal jejunal loop to the right and the ileocolic loop to the left side.…”