Prenatal Diagnosis of Small-Bowel Volvulus Using 3-Dimensional Doppler Sonography

Abstract

olvulus is generally a condition that occurs in the pediatric age group, commonly associated with intestinal malrotation. The intrauterine occurrence of this condition is a rare occasion, and only a few cases have been reported. Precise diagnosis is hampered by the extensive differential diagnoses of fetal intra-abdominal masses observed during sonographic examination. However, detection of the "whirlpool sign" facilitates sonographic diagnosis of this condition. We report a case of intestinal volvulus that occurred in utero diagnosed definitively with 2-dimensional and 3-dimensional (3D) Doppler sonography. To our knowledge, there is no previous report of such a case that was diagnosed by 3D Doppler sonography in the English literature. Case ReportA 50-year-old nulliparous woman was admitted to our maternity ward at 28 gestational weeks after decreased fetal movements. Her pregnancy was achieved with ovum donation and in vitro fertilization. She had 1 previous pregnancy that ended with a spontaneous miscarriage. Her medical history was unremarkable. Her routine follow-up results were normal during this pregnancy, including a fetal anatomic scan that was performed 3 weeks earlier.Initial evaluation revealed a nonstress test result of a reassuring fetal heart rate pattern and no uterine contractions. On fetal sonography, a singleton fetus was observed with a normal amniotic fluid index and no ascites or intraperitoneal echogenicity. However, a dilated stomach was seen, together with a fixed, dilated, Cshaped bowel loop in the upper part of the abdominal cavity (Figure 1). The affected bowel had a thick echogenic

Prenatal diagnosis of antenatal midgut volvulus: Specific ultrasound features

“…Among 13 cases, eight (61.5%) mothers reported a reduction in these movements. Because this sign is very unspecific and difficult to quantity or identify objectively, depending as it does on the mother's personal evaluation, it is rarely mentioned in the literature . However, in our case series, more than 50% of patients in this situation reported a decrease in fetal movements, which doesn't seems to be accidental.…”

“…Decreased active fetal movements in the literature. 13,14 However, in our case series, more than 50% of patients in this situation reported a decrease in fetal movements, which doesn't seems to be accidental. It appears that at the moment of the volvulus and/or the secondary intestinal perforation, the fetus, stunned by the pain, limits its movements.…”

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

“…In all the cases of intestinal volvulus described in the literature, an early neonatal laparotomy was performed with intestinal resection and either termino-terminal anastomosis at the same time [ 1 , 3 , 14 – 17 ] or temporary enterostomy with secondary restoration of intestinal continuity [ 4 , 6 , 11 , 18 – 20 ]. According to Raherison et al, ileostomy seems to be the best option in case of intestinal perforation or necrosis, or if there is atresia associated with peritonitis, because of a high risk of anastomotic leaks in an inflammatory or septic context.…”

“…Despite a few cases of neonates with postoperative short bowel syndrome [ 11 , 13 ], long-term prognosis was good overall with normal growth and feeding [ 1 , 4 , 6 , 11 , 13 – 16 , 18 , 20 ].…”