A Rare Association of Small Bowel Atresia and In-Utero Midgut Volvulus Presenting as Fetal Meconium Pseudocyst

Fetal meconium peritonitis (MP) is a rare occurrence. Neonate that survives this rare condition is likely to form a meconium pseudocyst. Hereby, we present a case of a 33-year-old pregnant woman that presented with premature rupture of membranes at 34 weeks of gestation. Antenatal ultrasonography at 33 weeks revealed abnormal dilated bowel within the viable fetus. An emergency Cesarean section was performed and a baby boy was delivered at 34 weeks. Physical examination of the baby at birth revealed a palpable central abdominal mass. Lower gastrointestinal contrast imaging revealed a non-opacified dilated proximal small bowel and opacified collapsed distal small bowels and colon. A laparotomy was carried out and revealed MP with pseudocyst formation due to a midgut volvulus. Interestingly, meconium contamination was confined due to associated atretic small bowel which occurred secondary to the volvulus.

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Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/5312179 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Emanuelle J. Best ◽

Cecelia M. O’Brien ◽

Wendy Carseldine ◽

Aniruddh Deshpande ◽

Rebecca Glover ◽

...

Keyword(s):

Small Bowel ◽

Abdominal Mass ◽

Uneventful Recovery ◽

Team Approach ◽

Midgut Volvulus ◽

Meconium Peritonitis ◽

Third Trimester ◽

Bowel Necrosis ◽

Threatening Condition ◽

Life Threatening

Background. Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis. Case Description. We present a case of fetal ileal volvulus suspected on third trimester ultrasound, complicated by premature labour, small bowel necrosis, and meconium peritonitis. Progressive dilatation and decreased peristalsis of echogenic bowel were noted in the early part of the third trimester. Daily surveillance ultrasound was performed and spontaneous labour occurred at 32 weeks’ gestation. A proactive postnatal approach guided by prenatal sonographic findings allowed prompt treatment and an urgent laparotomy was performed for an ileal volvulus with necrosis and meconium peritonitis. A segment of small bowel volvulus was resected and an end-to-end anastomosis was performed with uneventful recovery. Discussion. Clinically signs of fetal midgut volvulus are not pathognomonic, such as intestinal dilatation, abdominal mass, ascites, peritoneal calcifications, or polyhydramnios; thus, the diagnosis is often challenging. Complications reported in the literature include perforation and haemorrhagic ascites, which may lead to anaemia, hypovolemia, heart failure, and fetal demise. Conclusion. This case highlights the importance of assessing the fetal bowel as a part of routine third trimester ultrasound. The case describes the complexity of diagnosis in the fetus, important considerations along with multidisciplinary team approach to management.

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Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002588 ◽

2021 ◽

Author(s):

Cemal Ulusoy ◽

Andrej Nikolovski ◽

Nazım Öztürk

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Abdominal Mass ◽

Clinical Signs ◽

Rare Condition ◽

Abdominal Cocoon ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis ◽

Palpable Abdominal Mass

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.

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Dorsal mesenteric agenesis without small bowel atresia: a rare cause of midgut volvulus in children

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2006.05.011 ◽

2006 ◽

Vol 41 (9) ◽

pp. e5-e7 ◽

Cited By ~ 3

Author(s):

Salvatore Cascio ◽

Alan Sze Loong Tien ◽

Prakash Agarwal ◽

Hock Lim Tan

Keyword(s):

Small Bowel ◽

Midgut Volvulus ◽

Small Bowel Atresia ◽

Bowel Atresia

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Intestinal Malrotation with Midgut Volvulus leading to Small Bowel Obstruction in a Young Adult: A Case Report

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v9i2.520 ◽

2020 ◽

Vol 9 (2) ◽

pp. 149-152

Author(s):

Junaid Zia Hashmi ◽

Talha Kareem ◽

Masood ur Rauf Khan Hiraj

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Iliac Fossa ◽

Rare Condition ◽

Intestinal Malrotation ◽

Uneventful Recovery ◽

Midgut Volvulus ◽

Left Iliac Fossa ◽

Ladd’S Procedure

The developing intestine rotates around the superior mesenteric vessels during physiological herniation from 6th to 10th weeks of embryogenesis. Intestinal malrotation leading to midgut volvulus and small bowel obstruction is a rare condition. Patients who develop this condition usually present in the first year of their life. Intestinal malrotation is characterized by right sided duodenojejunal junction, caecum in left iliac fossa and a narrow mesentery. Ladd’s procedure is the treatment of choice which is done to restore the normal anatomy. We report the case of an 18-year-old male patient, who presented with intestinal malrotation in emergency department of Nishtar Hospital, Multan. It is an uncommon age for presentation of this anomaly. The patient had fecal peritonitis due to caecal perforation. He underwent Ladd’s procedure in which ileocolostomy was made after right hemicolectomy. The patient had an uneventful recovery after the surgery and had no complaints on follow up visit one week after the discharge.

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Agenesis of the dorsal mesentery presenting in an adolescent

South African Journal of Radiology ◽

10.4102/sajr.v17i1.204 ◽

2013 ◽

Vol 17 (1) ◽

pp. 16-18 ◽

Cited By ~ 1

Author(s):

Anith Chacko ◽

Farzanah Ismail ◽

Sirajudeen Ellemdin

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Rare Occurrence ◽

Jejunal Atresia ◽

Proximal Small Bowel ◽

Small Bowel Atresia ◽

Bowel Atresia ◽

Dorsal Mesentery

Agenesis of the dorsal mesentery is a rare occurrence that usually presents in children. It is associated with proximal small bowel malrotation as well as high jejunal atresia with discontinuity of the small bowel. We present a case report of an adolescent presenting with clinical features of proximal small bowel obstruction (confirmed on imaging) as well as acute pancreatitis. At laparotomy, he was found to have no dorsal mesentery, without small bowel atresia, and the duodenum was fixed to the posterior abdominal wall. The patient recovered well and remained symptom-free.

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An Uncommon Recurrent Metastasis of Ovarian Immature Teratoma to the Small Bowel

Case Reports in Oncology ◽

10.1159/000520950 ◽

2021 ◽

pp. 1834-1840

Author(s):

Mohammad Al‐hazaimeh ◽

Mahmoud Jaradat ◽

Mohammed El-Sadoni ◽

Tamara Smadi ◽

Ruba Shannaq ◽

...

Keyword(s):

Small Bowel ◽

Rare Case ◽

Abdominal Mass ◽

Germ Cell Tumors ◽

Pregnant Patient ◽

Immature Teratoma ◽

Imaging Studies ◽

Antenatal Ultrasonography ◽

First Time ◽

Variable Potential

Immature ovarian teratomas are rare ovarian germ cell tumors associated with a variable potential of distant metastasis. The acquisition of mature phenotypes upon post-treatment recurrence of immature teratomas has been previously described. In this study, we report, for the first time, a rare case of a recurrent ovarian immature teratoma with mature deposits in the small bowel. An incidental pelvi-abdominal mass was identified in a 30-year-old pregnant patient during antenatal ultrasonography. The mass, which was resected through salpingo-oopherectomy, was histopathologically characterized as an immature teratoma of grade 2 and treated with 3 cycles of chemotherapy. After 3 years of completing treatment, the patient suffered from severe anemia which was investigated by capsule endoscopy that identified a bleeding source in the ileum. Imaging studies revealed an intrabdominal mass that was resected laparoscopically. The pathological assessment of the mass identified a submucosal/intramuscular teratoma with mature elements indicative of a recurrent metastasis of immature teratoma associated with post-chemotherapy retroconversion. The secondary mass was then managed with adjuvant chemotherapy.

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Midgut Volvulus Due to a True Jejunal Diverticula

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0040-1721518 ◽

2020 ◽

Author(s):

Melissa Kyriakos Saad ◽

Amine Geahchan ◽

Fatimah Ghandour ◽

Fatmeh Ghandour-Hajj ◽

Hani Malouf ◽

...

Keyword(s):

Small Bowel ◽

Rare Condition ◽

Midgut Volvulus ◽

Rare Entity ◽

Small Bowel Volvulus

AbstractJejunal diverticula is a rare condition quoted to affect between 0.5% and 7% of the individuals. This disease is usually clinically silent but becomes symptomatic when complications develop. Among its complications is small bowel volvulus that is a very rare entity.

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Fetus in fetu: two case reports from North African country

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-020-00049-5 ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Moutaz Ragab ◽

Omar Nagy Abdelhakeem ◽

Omar Mansour ◽

Mai Gad ◽

Hesham Anwar Hussein

Keyword(s):

Histopathological Examination ◽

Case Reports ◽

Abdominal Mass ◽

Mature Teratoma ◽

Surgical Techniques ◽

Rare Condition ◽

Mass Effect ◽

Fetus In Fetu ◽

Vascular Connection ◽

First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

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