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Case Reports
. 2022 Nov:100:107742.
doi: 10.1016/j.ijscr.2022.107742. Epub 2022 Oct 11.

Intrauterine intestinal volvulus without malrotation presenting neonatal abdominal compartment syndrome

Hirokazu Matsushima  1 , Morihiro Katsura  2 , Masafumi Ie  1 , Ryuichi Genkawa  3
Affiliations
Case Reports

Intrauterine intestinal volvulus without malrotation presenting neonatal abdominal compartment syndrome

Hirokazu Matsushima et al. Int J Surg Case Rep. 2022 Nov.

Abstract

Introduction: Fetal intestinal volvulus without malrotation is extremely rare, and early prenatal diagnosis is challenging because the signs and symptoms are non-specific. However, without proper management, it can cause massive bowel necrosis.

Presentation of case: A woman experienced a dilated fetal bowel at 34 weeks of pregnancy and noticed a decrease in fetal movements at 36 weeks; however, she did not visit a hospital. Her newborn developed severe abdominal distension and was diagnosed with neonatal abdominal compartment syndrome with respiratory distress immediately after emergency caesarean section at 36 weeks and 5 days of pregnancy. The neonate underwent emergency exploratory laparotomy. This revealed a volvulus of the small bowel with extensive necrosis and no findings of congenital malrotation. While the patient required massive necrotic bowel resection, 80 cm of the small intestine was preserved.

Discussion: Fetal intestinal volvulus without malrotation can cause abdominal compartment syndrome with rapid respiratory distress. Therefore, it should be considered in the differential diagnosis of fetal intestinal dilatation. Volvulus exacerbation risk increases from 30 weeks of pregnancy to late preterm delivery. However, the time lag between the mother's awareness of decreased fetal movement and caesarean section makes early diagnosis challenging, resulting in a life-threatening condition for the neonate.

Conclusion: When a fetal ultrasound examination shows intestinal dilatation between gestational week 30 and late preterm, the mother must be fully informed about the possibility that the foetus has intestinal volvulus and the potential risk of massive fetal intestinal necrosis.

Keywords: Intestinal volvulus; Neonatology; Obstetrics; Pediatric surgery.

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Conflict of interest statement

Declaration of competing interest The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Figures

Fig. 1
Fig. 1
Prenatal ultrasound examination of the fetal abdomen shows intestinal dilatation of 24 mm and thickening of the intestinal wall during a prenatal checkup at 34 weeks of pregnancy (A), and intestinal dilation worsening of the diameter to 26 mm and the high intestinal brightness at 36 weeks and 5 days of pregnancy (B). Postnatal abdominal ultrasound examination shows dilated bowel loops and thickening of the intestinal wall (C, D), whereas meconium is detected from the sigmoid colon to the rectum without ascites (D).
Fig. 2
Fig. 2
Postnatal abdomen supine X-ray shows stomach gas without bowel gas passage and prominent diaphragmatic elevation.
Fig. 3
Fig. 3
Physical examination reveals severe abdominal distention showing bluish-white skin discolouration of the abdominal wall.
Fig. 4
Fig. 4
On laparotomy, the ileum was twisted about four-fold clockwise and showed extensive bowel necrosis.
See this image and copyright information in PMC

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