Volvulus

Volvulus

Description

Volvulus may occur with other bowel conditions and may result in the necrosis of a large amount of bowel. The prognosis is poor with about an 80% mortality. The occurrence of fetal distress in the presence of the condition is recognised and may arise either as a feature of central shock or perhaps shock arising from loss of fluid.

Diagnosis

The appearance of a complex intra-abdominal mass is typical. The bowel will become very distended and sonolucent as it fills with fluid. Particulate matter may be observed within the bowel and peristalsis may cease. Ascites may develop. Once the acute phase is over the baby may start to move again but the bowel remains dilated although motility may return.

Differential Diagnosis

Other forms of bowel obstruction must be considered. Jejunal and ileal atresias are probably the commonest but they are not usually associated with fetal distress or the development of ascites. In other words the baby remains in good condition. Other cyst structures such as reduplications are not usually obstructive.

Sonographic Features

Dilated loops of fluid-filled bowel

Complex intra-abdominal mass

Ascites may develop and the abdomen become distended

The fetus may show signs of distress with reduced movements

Associated Syndromes

  • Caudal regression/ sirenomelia sequence
  • Intestinal atresias
  • OEIS complex
  • Simpson-Golabi-Behmel syndrome

References

Witter FR, Molteni RA Intrauterine intestinal volvulus with hemoperitoneum presenting as fetal distress at 34 weeks gestation Am J Obstet Gynecol 155;1080-1081


Mercado MG, Bulas DI, Chandra R Prenatal diagnosis and management of congenital volvulus Pediar Radiolo 23;601-602