All neonates with prenatal
intestinal volvulus managed in our institution between May 2004 and December 2010 were retrospectively studied. All neonates with prenatal or neonatal diagnosis of prenatal
intestinal volvulus were included. We analyzed age at diagnosis, fetal ultrasound (US) scan and magnetic resonance imaging (MRI) findings, clinical signs at birth, surgical findings, management, and postoperative outcome.
RESULTS: Ten neonates with prenatal
intestinal volvulus were identified. Prenatal US scans or MRI demonstrated evidence of meconium
peritonitis in one fetus and bowel dilatation in 2 others. The mean gestational age at birth was 36 weeks (range, 31-38 weeks) and the mean
birth weight was 2811g (range, 2050-3700g). One premature neonate developed respiratory distress and required ventilatory support at birth. In 7 neonates, clinical examination showed distended abdomen and
emesis, whereas plain abdominal radiographs showed
intestinal obstruction. All neonates underwent surgery and all had normal intestinal rotation, except one with total
intestinal volvulus secondary to malrotation. Other causes of
volvulus were suspected in 4 neonates: mesenteric defect (n=1),
intestinal atresia (n=2) and narrow mesentery (n=1). Detorsion of total
volvulus,
ileostomy, or intestinal resection with primary anastomosis was performed in 2, 5, and 3 neonates, respectively. One patient with total
intestinal volvulus secondary to malrotation died, whereas all other neonates survived. In one patient, the postoperative course was complicated by intestinal dysmotility of the distal small bowel requiring a secondary jejunoileostomy. Stoma closure was subsequently performed at 1 year of age with good outcome. One patient developed angiocholitis treated successfully with
antibiotics. Median time to initiate enteral feeds was 7 days (range, 4-16 days) and all patients were subsequently weaned from
parenteral nutrition. Median duration of
parenteral nutrition was 29 days (range, 6-667 days). None of the patients had
cystic fibrosis. Unlike postnatal
volvulus, most prenatal
volvulus occurs without malrotation. Although prenatal
volvulus is a life-threatening condition, our results suggest that good long-term outcome can be achieved in most cases.