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Case Reports
. 2025 Aug 7:13:1586328.
doi: 10.3389/fped.2025.1586328. eCollection 2025.

Case Report: Ultrasound "whirlpool sign" in fetal intestinal malrotation and torsion: a case-based approach to early diagnosis and intervention

Yueyun Liu  1 , Rongjie Zheng  2 , Zonghua Liu  1 , Jun Zhou  3
Affiliations
Case Reports

Case Report: Ultrasound "whirlpool sign" in fetal intestinal malrotation and torsion: a case-based approach to early diagnosis and intervention

Yueyun Liu et al. Front Pediatr. .

Abstract

Introduction: Fetal ascites is a rare condition that may indicate underlying gastrointestinal malformations, including congenital intestinal malrotation. Early recognition and timely intervention are crucial to prevent complications such as intestinal torsion and ischemic necrosis. This study reports a case of fetal intestinal malrotation presenting with isolated ascites and acute fetal distress, emphasizing the role of ultrasound and multidisciplinary management in improving neonatal outcomes.

Case report: A late-term fetus presented with reduced fetal movements. Ultrasound revealed moderate ascites, bowel dilation, and the characteristic "whirlpool sign," suggesting intestinal malrotation with volvulus. Doppler ultrasound indicated abnormal umbilical artery blood flow, and cardiotocography (CTG) confirmed fetal distress. An emergency cesarean section was performed after a multidisciplinary consultation. Intraoperative findings revealed intestinal volvulus, and postoperative evaluation confirmed ischemic necrosis. The neonate underwent abdominal paracentesis and received comprehensive treatment, including respiratory support, antimicrobial therapy, and nutritional management. Histopathological examination confirmed localized intestinal necrosis without perforation. The infant recovered well and was discharged in stable condition.

Conclusion: Fetal ascites may be an early sign of congenital intestinal malrotation and volvulus. The ultrasound "whirlpool sign" indicates intestinal malrotation and possible volvulus, aiding early detection but not confirming bowel necrosis. Prompt multidisciplinary decision-making is essential to improve perinatal outcomes and prevent severe complications.

Keywords: fetal ascites; fetal distress; intestinal malrotation; perinatal management; ultrasound whirlpool sign; volvulus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Changes and abnormalities in fetal heart rate monitoring. (A) Fetal heart rate monitoring (external hospital: absence of baseline variability and accelerations); (B) fetal heart rate monitoring (our hospital: flattened baseline with a sinusoidal pattern).
Figure 2
Figure 2
Prenatal ultrasound showing the characteristic “whirlpool sign” and fetal ascites. The image demonstrates the characteristic “whirlpool sign,” formed by the mesenteric vessels spiraling around the superior mesenteric artery, indicating fetal intestinal volvulus. A 2.3 cm anechoic area is also visible in the abdominal cavity, consistent with fetal ascites.
Figure 3
Figure 3
Abdominal x-ray showing high-density imaging in the gastrointestinal region. High-density imaging suggests gastrointestinal obstruction or intra-abdominal fluid accumulation.
Figure 4
Figure 4
Ultrasound shows fluid-filled hypoechoic areas around the liver and spleen, as well as cardiac structural and functional abnormalities. (A) Hypoechoic fluid-filled areas around the liver and spleen; (B) neonatal echocardiography showing cardiac structural and functional abnormalities.
Figure 5
Figure 5
Intraoperative findings of intestinal torsion and necrosis. (A) Intraoperative reduction of intestinal torsion; (B) resected necrotic small intestine.
Figure 6
Figure 6
Schematic diagram of surgical procedures for intestinal necrosis resection (created by bioRender).
Figure 7
Figure 7
Workflow diagram for fetal ultrasound diagnosis.
See this image and copyright information in PMC

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