Liu Yueyun, Zheng Rongjie, Liu Zonghua, Zhou Jun
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
Department of Obstetrics and Gynecology, Shandong First Medical University, Jinan, China.
Front Pediatr. 2025 Aug 7;13:1586328. doi: 10.3389/fped.2025.1586328. eCollection 2025.
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.
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.
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.
胎儿腹水是一种罕见病症，可能提示潜在的胃肠道畸形，包括先天性肠旋转不良。早期识别和及时干预对于预防诸如肠扭转和缺血性坏死等并发症至关重要。本研究报告了一例以孤立性腹水和急性胎儿窘迫为表现的胎儿肠旋转不良病例，强调了超声检查和多学科管理在改善新生儿结局方面的作用。
一名晚期胎儿出现胎动减少。超声检查显示中度腹水、肠扩张以及特征性的“漩涡征”，提示肠旋转不良伴肠扭转。多普勒超声显示脐动脉血流异常，胎心监护（CTG）证实胎儿窘迫。经过多学科会诊后进行了急诊剖宫产。术中发现肠扭转，术后评估证实存在缺血性坏死。新生儿接受了腹腔穿刺，并接受了包括呼吸支持、抗菌治疗和营养管理在内的综合治疗。组织病理学检查证实为局限性肠坏死，无穿孔。婴儿恢复良好，病情稳定后出院。
胎儿腹水可能是先天性肠旋转不良和肠扭转的早期迹象。超声“漩涡征”提示肠旋转不良及可能的肠扭转，有助于早期发现，但不能确诊肠坏死。迅速的多学科决策对于改善围产期结局和预防严重并发症至关重要。
