Ohuoba Esohe, Fruhman Gary, Olutoye Oluyinka, Zacharias Nikolaos
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas ; Esohe Ohuoba and Gary Fruhman contributed equally to this manuscript.
AJP Rep. 2013 Oct;3(2):107-12. doi: 10.1055/s-0033-1349367. Epub 2013 Jul 11.
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 37(6/7) 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.
胎儿肠扭转是一种罕见的危及生命的疾病。肠扭转的晚期诊断导致高发病率和死亡率。其表现程度和存活率各不相同。宫内肠扭转可能因缺血性坏死而并发肠闭锁。据我们所知，有3例足月胎儿死亡的报道。我们报告了1例胎儿肠扭转病例，该足月婴儿是迄今为止报道的患有这种并发症且围产期存活的最大婴儿。肠扭转与3A型空肠闭锁相关，产前超声检查发现肠道病变。婴儿在妊娠37(6/7)周时通过紧急剖宫产出生，并接受了紧急剖腹探查术，切除小肠并进行一期端端吻合。宫内肠扭转在产前超声检查中可能被怀疑，但只有在出生后才能明确诊断。胎儿窘迫和肠扭转的体征很少与足月胎儿存活的报道相关。我们回顾了已报道的产前疑似肠扭转且存活至新生儿期后的婴儿病例。由于胎儿肠扭转和大多数肠闭锁/狭窄在妊娠晚期出现，我们建议在32至36周的生长超声检查中，有限的胎儿解剖学检查应常规包括对胎儿肠道的评估。
