Analysis of the Clinical Course of Fetal and Neonatal Intestinal Volvulus Without Malrotation

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  • Inoue Seiichiro
    Department of Pediatric Surgery, Saitama Medical Center, Saitama Medical University
  • Odaka Akio
    Department of Pediatric Surgery, Saitama Medical Center, Saitama Medical University
  • Muta Yuki
    Department of Pediatric Surgery, Saitama Medical Center, Saitama Medical University
  • Takeuchi Yuta
    Department of Pediatric Surgery, Saitama Medical Center, Saitama Medical University
  • Kabe Kazuhiko
    Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University
  • Baba Kazunori
    Division of Maternal and Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University

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Other Title
  • Intestinal volvulus without malrotationの診断時期と治療成績の検討
  • Intestinal volvulus without malrotation ノ シンダン ジキ ト チリョウ セイセキ ノ ケントウ

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Abstract

<p>Purpose: Fetal and neonatal intestinal volvulus without malrotation (IVWM) is a serious life-threatening condition. An early and appropriate neonatal surgical management significantly improves the outcome. However, because intestinal volvulus is generally associated with malrotation, IVWM shows none of the specific clinical signs for presurgical diagnosis and thus its diagnosis is considered to be difficult. Here, we present our institution’s experience with presurgical diagnosis and the clinical courses of 16 IVWM cases.</p><p>Methods: A retrospective study reviewing the clinical records of IVWM cases managed in Saitama Medical Center from January 2013 to December 2019.</p><p>Results: A total of 16 IVWM patients received surgical management in our center. The patients were divided in two groups according to their time of diagnosis, that is, prenatally diagnosed (group A and B) and postnatally diagnosed (group C and D), with eight infants per group. Patients in group A and B were prenatally diagnosed with an abdominal anomaly during prenatal ultrasonography follow up, four of which showed the typical whirlpool configuration (group A). The remaining four patients showed fetal intestinal dilatation with ascites (group B). One patient of this group was born prematurely (GA 28 weeks and 0 days) and died. Patients in group C and D were diagnosed after birth, four of which presented with symptoms and signs of ileus from 1 to 7 days of life (group C). Four patients were diagnosed intraoperatively as having IVWM after being initially misdiagnosed for other causes of ileus (group D). All patients in group C and D survived.</p><p>Conclusion: In our institution, the clinical courses of IVWM cases were mainly divided into two groups according to the time of diagnosis, that is, prenatal or postnatal. In the prenatally diagnosed group, early preterm delivery may have a considerable effect on prognosis. Understanding the clinical course patterns of IVWM in infants may help reach an appropriate diagnosis and an early surgical treatment, and hence a better prognosis.</p>

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