RESUMEN
BACKGROUND: Ileal atresia is a congenital abnormality where there is significant stenosis or complete absence of a portion of the ileum. The overall diagnostic accuracy of prenatal ultrasound in detecting jejunal and ileal atresia is low. We report a case of ileal atresia diagnosed prenatally by ultrasound examination with the "keyboard sign" and "coffee bean sign". CASE SUMMARY: We report a case of ileal atresia diagnosed in utero at 31 weeks' of gestation. Prenatal ultrasound examination revealed two rows of intestines arranged in an 'S' shape in the middle abdomen. The inner diameters were 1.7 cm and 1.6 cm, respectively. A typical "keyboard sign" was observed. The intestine canal behind the "keyboard sign" showed an irregular strong echo. There was no normal intestinal wall structure, showing a typical "coffee bean sign". Termination of the pregnancy and autopsy findings confirmed the diagnosis. CONCLUSION: The prenatal diagnosis of ileal atresia is difficult. The sonographic features of the "keyboard sign" and "coffee bean sign" are helpful in diagnosing the location of congenital jejunal and ileal atresia.
RESUMEN
Intrauterine volvulus is an extremely rare disorder. Its diagnosis is difficult to make antenatally, unless typical pictures are obtained. Owing to its high morbidity and mortality, intensive monitoring of the fetal condition is mandatory. Here, we report a patient, gravida 4, para 1 (G4P1), who had suffered from preterm labor and diminishing fetal movement and was brought to the emergency unit after her 35th week of pregnancy. Ultrasonography was performed to reveal a fetus with a markedly distended bowel (18 mm in width). Intestinal obstruction related to intrauterine volvulus was highly suspected. The fetus was delivered via Cesarean section because of its deteriorated abdominal condition. Urgent exploratory laparotomy was done by a pediatric surgeon to relieve the bowel obstruction on the second day after birth, on the account of poor improvement of the newborn. The newborn did well after segmental resection and was subsequently followed up at the pediatric outpatient clinic. In conclusion, early detection, intensive monitoring, prompt delivery, and urgent surgical intervention are the key to save the fetal life and neonatal health.
RESUMEN
Sigmoid volvulus is a rare cause of intestinal obstruction in the pediatric age group. Rotation of the redundant sigmoid colon about its narrow mesenteric base results in vascular compromise and large bowel obstruction. Predisposing factors for sigmoid volvulus are Hirschsprung's disease, congenital anomalous fixation of the colon, and chronic constipation. Here, we report two cases of sigmoid volvulus in children with redundant sigmoid colon in the South Indian subcontinent. If it is not diagnosed in time, it may lead to serious complications such as gangrene, perforation, septic shock, and eventually death. Thus, the condition warrants prompt evaluation and treatment.
RESUMEN
Teaching Point: The coffee bean sign, the whirl sign, and the bird's beak sign are the key findings on abdominal CT of cecal volvulus.
RESUMEN
The presence of the coffee bean sign is pathognomonic of sigmoid volvulus.
RESUMEN
BACKGROUND: Sigmoid volvulus is frequently reported in the "volvulus belt" (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause of large bowel obstruction in North America. It is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to diagnose sigmoid volvulus in children. CASE PRESENTATION: We present a 13-year-old Arabian girl who came with features suggestive of intestinal obstruction. Plain abdominal film revealed classic omega (coffee bean) sign of sigmoid volvulus. The volvulus was successfully decompressed by means of a rectal tube in our emergency department. The next day during the same admission the volvulus recurred and was successfully decompressed by endoscopy. She was discharged home on her parents' request; she presented again 1 month later. This time the volvulus could not be decompressed non-operatively, so she underwent sigmoidectomy with primary anastomosis. Postoperatively she developed paralytic ileus that resolved after 10 days. Following that she did well and was discharged home. She is still free of symptoms 1 year after the resection. CONCLUSIONS: Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group as a cause of intestinal obstruction. Pediatric surgeons should maintain a high index of suspicion, in order not to miss this important diagnosis, as any delay in instituting treatment has a devastating effect on morbidity as well as mortality. Early diagnosis and prompt treatment confer an excellent prognosis.
Asunto(s)
Vólvulo Intestinal , Enfermedades del Sigmoide , Adolescente , Anastomosis Quirúrgica , Colectomía , Descompresión Quirúrgica , Servicio de Urgencia en Hospital , Femenino , Humanos , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/fisiopatología , Vólvulo Intestinal/terapia , Radiografía Abdominal , Recurrencia , Enfermedades del Sigmoide/diagnóstico por imagen , Enfermedades del Sigmoide/fisiopatología , Enfermedades del Sigmoide/terapia , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate whether prenatal diagnosis of intestinal midgut volvulus (a rare condition due to the small bowel loops twisting) can improve the prognosis of the newborns. METHODS: In our Prenatal Diagnosis Center, eight cases of intestinal volvulus observed between 2007 and 2014 were retrospectively considered. Ultrasonographic signs can be direct and specific (whirlpool sign, coffee bean sign) or indirect and non-specific (abdominal mass, dilated bowel loops, pseudocysts, ascites, polyhydramnios). RESULTS: Prenatal diagnosis was performed at 20-34 weeks of gestation. All newborns were exposed to an emergency surgery: the major complication was due to cystic fibrosis. CONCLUSIONS: An early suspicion of intestinal volvulus allows the clinician to refer the patient to a tertiary center so to confirm the diagnosis and perform an appropriate follow-up in order to identify the proper time of delivery. The prognosis of the babies with prenatal intestinal volvulus depends on the length of the segment involved, on the level of intestinal obstruction, on the presence of meconium peritonitis and on the gestational age at birth. Our experience, according with the literature, suggests that ascites and absence of abdominal peristalsis are ultrasonographic signs that, in the third trimester of pregnancy, correctly lead to an immediate delivery intervention.
Asunto(s)
Enfermedades Fetales/diagnóstico por imagen , Vólvulo Intestinal/diagnóstico por imagen , Fibrosis Quística/complicaciones , Parto Obstétrico , Femenino , Enfermedades Fetales/cirugía , Humanos , Vólvulo Intestinal/cirugía , Peritonitis/complicaciones , Embarazo , Diagnóstico Prenatal , Estudios Retrospectivos , UltrasonografíaRESUMEN
Intestinal volvulus is a common condition seen in infancy and adulthood, but small bowel volvulus is a rare condition affecting the fetus in utero. Very few cases have been reported describing the ultrasound findings of the same. We present a case report of a case of intestinal volvulus which was diagnosed prenatally based on the ultrasound features of whirlpool sign and coffee bean sign. An emergency caesarian section was performed, small bowel volvulus was confirmed on post-natal ultrasound, and the neonate was subsequently operated. Although these signs have been separately described previously in the literature, in our case both these signs were seen in the same patient. Our case is a rare presentation with the occurrence of volvulus without malrotation, the contrary being more common.