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Acute fetal intestinal volvulus
MRI-Ultrasound Aspects
About a case report

Fig1: Ultrasound of dilated bowel loops  

Fig2: Ultrasound, cockade

Fig3 : doppler, no signal

 Fig4: Ultrasound, ileal loops

Fig5: MRI, sagittal T2, bowel obstruction above the mesocolon

Fig6: MRI , coronal T2 , central abdominal cockade

Fig7: MRI, T1 weighted- sequence, dilated bowel loops in hypersignal

Fig8: MRI, T2, cockade

Photo 1: newborn at birth,  distended abdomen

Photo 2 : jejunal volvulus

Photo 3 : jejunal volvulus

Photo 4: bowels obstructed by meconium beads

Case report :

We report the history of an acute intestinal volvulus that occurred at 32 weeks in a primiparous, one that presents in emergency for a marked decrease in fetal movement.

The ultrasound so far normal, shows a significant intestinal distention in the form of intra-abdominal fluid images with thickened wall animated with peristaltic movement.

Situated at the centre of the subhepatic regions, these bowel loops show a heterogeneous liquid content.  

Moreover, a thin ascites film surrounds these dilated bowels.

This distention occurs upstream of a rounded image as a multi-centric cockade allowing to approach the diagnosis of intestinal volvulus.

Two negative signs to be noted : the absence of Doppler flow within the intestinal cockade and polyhydramnios.

In the Ultrasound hall, the patient undergoes MRI of the same site.

T2 and T1-weighted sequences enable to confirm intestinal volvulus on meconium ileus.

The image can be superimposed on the ultrasound cockade with dilated anterosuperior bowel loops contrasting with flattened ileal loops.

The meconium origin of this volvulus is retained on the T1 hyperintense aspect of the dilated bowel loops.

Following the MRI ultrasound data, a caesarean section was performed to extract a 1.8 kg baby girl in respiratory distress requiring intubation and ventilation.

Laparotomy confirms the segmental volvulus of two loops at the jejunoileal junction with necrosis on meconium beads. Resection of about fifteen centimetres of the bowel.

The immediate postoperative is normal.

Comments :

Intestinal volvulus is rarely reported in the Literature.

It is a real fetal emergency seriously affecting the vital prognosis by necrosis and meconium peritonitis.

Its ultrasound aspect is typical in the form of a multi-centric rounded cockade.

A snail-like image responsible for an upstream intestinal dilatation.

MRI is an essential examination in the exploration of the fetal digestive tract. Due to a T1 hyperintense effect of meconium, it makes it possible to establish a genuine mapping of the digestive tract. The reported observation perfectly illustrates the good ultrasound-MRI correlation.

Conclusion :

Intestinal volvulus in the fetus is rarely reported. This is a real vital emergency.

The Ultrasound and MRI image is typical of this complication.

It enables early diagnosis and contributes to adequate management, the only guarantee of the improvement in the prognosis of an extremely severe complication.

References :
1 -Prenatal diagnosis and management of an intestinal volvulus with meconium ileus and peritonitis, Takacs ZF , Meier CM , Solomayer EF Arch Gynecol Obstet 2014 Aug 290 (2) 385-7
2 -Prenatal intestinal volvulus : look for cystic fibrosis Chouikh T, Mottet N, Chaussy Y BJM case report 2016 Dec 21.
3- Prenatal magnetic resonance and ultra sonographic findings in small bowel obstruction: Imaging clues and post natal outcomes . Rubio EL , Blask AR , Badillo AT , BulasDI Pediatr Radiol 2017 Apr , 47 (4) 411-21
4 – Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants: A Critically Appraised Topic, Caroll AG , Kavanagh RG , Cullinan NM , Lavelle LP , Maloue DE Acad Radiol 2016 May 23 (5) 559-68
5- Segmental Volvulus in the neonate : A particular clinical entity Khen Dunlop N , and Al J.Pediatr Surg 2017 Mar 52(3) 454-7
6- Prenatal Sonographic Diagnosis of meconium peritonitis from duodenal atresie Neeraja Chaudrasekaran , Denise Bernadette , Lisa Cariello , Diego Meraz BJM case report 2017 dec 10