Midgut Volvulus Causing Fetal Demise in Utero

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.

Congenital Midgut Volvulus Associated with Fetal Anemia

“…A situation similar to our case was presented by Steffensen et al [11] . They described in utero demise of a fetus in which the postmortem examination showed a congenital volvulus with an accumulation of about 200 ml of fluid in the lumen of the bowel.…”

“…Both our and the 2 previously described cases [10,11] indicate an association of fetal anemia with congenital volvulus. It is believed that coexisting fetal anemia is a consequence of impaired venous return from the dilated bowel loop which leads to passive congestion [12] .…”

Intestinal malrotation – volvulus: Imaging findings

“…6,20,42 Rarely the MI volvulus occurs weeks or months before delivery and is not usually lethally intrauterine fetal trauma. 6,43 The radiologic findings of prenatal volvulus are usually non-specific like free peritoneal liquid and dilated loops that can be hypointense in T2 in cases of hemorrhagic necrosis. 43,44 The intestinal content passing through the peritoneal cavity can create one pseudo-cyst, and originate one fibroadhesive peritonitis with calcifications or intestinal atresia seen at birth only.…”

A Case of a Preterm Infant with Prenatally Diagnosed Intrauterine Midgut Volvulus

“…15 The diagnosis of intrauterine midgut volvulus has become easier with high resolution image technology. Ultrasound findings re vealed the hallmark whirlpool sign in which the bowel and accompanying mesentery and vessel wrap around the main superior mesenteric artery.…”