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胎儿肠扭转的产前诊断与治疗:一例报告

Prenatal diagnosis and treatment of fetal intestinal volvulus: A case report.

作者信息

Zeng Xiaoyan, Li Xiang, Mo Weinong, Zhu Xuefen

机构信息

Department of Neonatology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China.

Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, Zhejiang, China.

出版信息

Medicine (Baltimore). 2025 Jan 17;104(3):e41337. doi: 10.1097/MD.0000000000041337.

DOI:10.1097/MD.0000000000041337
PMID:39833046
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11749602/
Abstract

RATIONALE

Fetal intestinal volvulus, a rare and severe disorder, poses significant diagnostic challenges prenatally and can lead to intrauterine death or adverse neonatal outcomes if untreated in a timely manner. This study reports a case of fetal intestinal volvulus confirmed postoperatively, providing insights into its clinical manifestations, diagnostic methods, and treatment outcomes, thereby enhancing understanding of this rare condition.

PATIENT CONCERNS

A Chinese gravida 2, para 1 female presented at 32 weeks and 5 days of gestation with decreased fetal movements. Fetal ultrasound and MRI revealed small intestinal torsion and obstruction. Due to fetal distress, an emergency cesarean section was performed, followed by an urgent laparotomy on the neonate to untwist the intestinal volvulus and resect the necrotic bowel segment.

DIAGNOSIS

Fetal intestinal volvulus.

INTERVENTIONS

Following an emergency cesarean section, the neonate was promptly transferred to the surgical department for immediate surgical intervention. The procedure encompassed detorsion of the intestinal volvulus and resection of the necrotic bowel segment.

OUTCOMES

The infant exhibited a satisfactory postoperative recovery, successfully transitioned to complete oral and gastrointestinal nutrition, and demonstrated normal physical growth and cognitive development during the ensuing follow-up period.

LESSONS

Fetal intestinal volvulus requires multidisciplinary collaboration for diagnosis and treatment. Early recognition, prompt delivery, and urgent surgical intervention are crucial for optimizing neonatal outcomes. By sharing this case, we hope to enhance the diagnostic and therapeutic capabilities of healthcare providers in managing this rare but severe condition.

摘要

理论依据

胎儿肠扭转是一种罕见且严重的疾病,在产前诊断面临重大挑战,如果不及时治疗,可导致宫内死亡或不良新生儿结局。本研究报告一例术后确诊的胎儿肠扭转病例,深入探讨其临床表现、诊断方法和治疗结果,从而增进对这种罕见疾病的了解。

患者情况

一名中国孕2产1女性,孕32周5天时出现胎动减少。胎儿超声和磁共振成像显示小肠扭转和梗阻。因胎儿窘迫,行急诊剖宫产,随后对新生儿紧急剖腹探查以扭转肠扭转并切除坏死肠段。

诊断

胎儿肠扭转。

干预措施

急诊剖宫产后,新生儿立即转入外科进行紧急手术干预。手术包括扭转肠扭转和切除坏死肠段。

结果

婴儿术后恢复良好,成功过渡到完全经口和胃肠道营养,在随后的随访期间身体生长和认知发育正常。

经验教训

胎儿肠扭转的诊断和治疗需要多学科协作。早期识别、及时分娩和紧急手术干预对于优化新生儿结局至关重要。通过分享该病例,我们希望提高医疗服务提供者对这种罕见但严重疾病的诊断和治疗能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/b81397bd15f0/medi-104-e41337-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/5d1861042067/medi-104-e41337-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/e8c3ba92ea22/medi-104-e41337-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/b81397bd15f0/medi-104-e41337-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/5d1861042067/medi-104-e41337-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/e8c3ba92ea22/medi-104-e41337-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/def4/11749602/b81397bd15f0/medi-104-e41337-g003.jpg

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J Clin Med. 2023 Jul 20;12(14):4790. doi: 10.3390/jcm12144790.
2
Mendelian randomization.孟德尔随机化
Nat Rev Methods Primers. 2022 Feb 10;2. doi: 10.1038/s43586-021-00092-5.
3
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J Med Case Rep. 2022 Dec 28;16(1):482. doi: 10.1186/s13256-022-03720-0.
4
Prenatal imaging features and perinatal outcomes of foetal volvulus-A literature review.胎儿肠旋转不良的产前影像学特征及围产儿结局——文献综述
Prenat Diagn. 2022 Feb;42(2):192-200. doi: 10.1002/pd.6083. Epub 2022 Jan 4.
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Intrauterine midgut volvulus as a rare cause of intestinal obstruction: a case report.子宫内中肠扭转作为肠梗阻的罕见病因:病例报告。
J Med Case Rep. 2021 May 4;15(1):239. doi: 10.1186/s13256-021-02778-6.
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Fetal intestinal volvulus without malrotation detected on prenatal ultrasound.
Pediatr Int. 2021 Jul;63(7):845-846. doi: 10.1111/ped.14550. Epub 2021 Apr 20.
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Prenatal diagnosis of antenatal midgut volvulus: Specific ultrasound features.产前诊断产前中肠扭转:特定的超声特征。
Prenat Diagn. 2019 Jan;39(1):16-25. doi: 10.1002/pd.5392. Epub 2018 Dec 9.
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Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound.产前超声检测到的胎儿中肠扭转合并胎粪性腹膜炎
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