Midgut volvulus diagnosed after therapeutic hypothermia for hypoxic-ischemic encephalopathy

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  • Fusagawa Shintaro
    Department of Pediatrics, Sapporo Medical University School of Medicine
  • Terada Kojiro
    Department of Pediatrics, Sapporo Medical University School of Medicine
  • Igarashi Risa
    Department of Pediatrics, Sapporo Medical University School of Medicine
  • Sakai Takuro
    Department of Pediatrics, Sapporo Medical University School of Medicine

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  • 低酸素性虚血性脳症に対する低体温療法後に診断された中腸軸捻転

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Abstract

<p> Midgut volvulus is often diagnosed with bilious vomiting, but is rarely associated with hypoxic-ischemic encephalopathy（HIE）. Here, we report a case of midgut volvulus diagnosed after therapeutic hypothermia for HIE without bilious vomiting. The patient was a female infant born at 40 weeks and two days of gestation, with a birth weight of 3,202 g and Apgar scores of 1 and 3 at 1 and 5 min, respectively. Therapeutic hypothermia was administered for moderate HIE. Tachycardia during hypothermia and increased gastric residuals after sedation termination were observed. On postnatal day 5, she had bloody stools, and an abdominal ultrasound revealed a midgut volvulus. There was extensive intestinal blood flow disturbance, but it improved after the volvulus was released and intestinal resection was spared. In the combination of HIE and midgut volvulus, the symptoms of midgut volvulus may not be obvious, and the diagnosis may be delayed owing to sedation and nutritional management during therapeutic hypothermia, resulting in a worse prognosis. It is important to pay attention to subtle signs and to search aggressively by using abdominal ultrasonography and other methods.</p>

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