Fetal midgut volvulus as a sign for cystic fibrosis

Durand, Marie-France; Coste, Karen; Martín, Alfonso Arranz; Scheye, T; Creveaux, Isabelle; Vanlieferinghen, P; Laurichesse‐Delmas, H.; Déchelotte, P.; Labbé, A.; Jacquetin, B.; Lémery, D.; Gallot, Denis

doi:10.1002/pd.2086

Cited by 16 publications

(31 citation statements)

References 8 publications

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“…Firstly, the classic type is defined as malposition of bowel due to clockwise rotation of the small bowel and ascending colon, around the superior mesenteric artery without evidence of any anomaly predisposing to the rotation [ 6 ]. Segmental volvulus has been described as twisting of bowel loops due to an anomaly such as meconium ileus (related to cystic fibrosis), atresia, mesenteric defects, duplication or mesenteric cysts, congenital diaphragmatic hernia or abdominal wall defects, or alternatively can be classified as idiopathic [ 7 ]. Lastly, volvulus without malposition is a diagnosis of exclusion and is more common in extremely premature or low birthweight infants [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound

Best

O’Brien

Carseldine

et al. 2018

Case Reports in Obstetrics and Gynecology

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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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Section: Discussionmentioning

confidence: 99%

Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound

Best

O’Brien

Carseldine

et al. 2018

Case Reports in Obstetrics and Gynecology

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“…In many cases, non-specific features, such as distended bowel loops, ascitis or hydramnios with normal position of mesenteric vessels were described on fetal ultrasound scans or MRI. In few studies the diagnosis of volvulus without malrotation was advanced when ultrasound scan revealed a long segment of bowel loops which formed a mass with a typical whirlpool or snail configuration, whereas others reported the ‘coffee bean sign’ 3 8 9. Like in our cases, some authors had reported that the appearance of a curved anechoic mass was a suggestive sign of segmental volvulus 3 8…”

Section: Discussionmentioning

confidence: 52%

“…Since spontaneous or deliberate preterm delivery might occur, a course of prenatal corticosteroids therapy should be given to the pregnant woman in order to improve fetal pulmonary maturation. Owing to the risk of intestinal necrosis and fetal death, some authors recommended immediate delivery despite the risk of mild prematurity 8. In our cases, emergent premature delivery was decided at 30 and 34 GW, respectively.…”

Section: Discussionmentioning

confidence: 84%

Prenatal intestinal volvulus: look for cystic fibrosis

et al. 2016

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Intestinal volvulus is a life-threatening emergency requiring prompt surgical management. Prenatal intestinal volvulus is rare, and most are secondary to intestinal atresia, mesenteric defect or without any underlying cause. Cystic fibrosis (CF) is known to cause digestive tract disorders. After birth, 10-15% of newborns with CF may develop intestinal obstruction within a few days of birth because of meconial ileus. This obstruction is a result of dehydrated thickened meconium obstructing the intestinal lumen. We report two cases of fetuses with prenatal diagnosis of segmental volvulus in whom CF was diagnosed.

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“…The fetus was notably affected by cystic fibrosis—characterized by viscous mucous secretions that can obstruct the bowel lumen, thus predisposing to volvulus. In contrast, Durand et al reported a case of perinatal survival at 39 weeks of a fetus with compound heterozygosity for mutations at ΔF508 and Y1092X 15. Steffensen et al reported a case of fetal demise at 38 weeks of gestation, due to cardiovascular failure and shock from midgut volvulus; the fetus also had intestinal atresia and arthrogryposis 6.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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Fetal midgut volvulus as a sign for cystic fibrosis

Cited by 16 publications

References 8 publications

Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound

Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound

Prenatal intestinal volvulus: look for cystic fibrosis

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

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