Felix Richter , Vanessa Eddy-Abrams , Harsha K. Garg , Peter S. Midulla , Veniamin Ratner
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However, the large volume, bilious color, persistent output, unexplained respiratory distress, and elevated bilirubin prompted an upper GI series (UGIS). The UGIS was consistent with a proximal obstruction that was likely present from birth. The patient underwent exploratory laparotomy which revealed a volvulus from malrotation that was repaired with detorsion and Ladd procedure. Despite a dusky bowel suggestive of ischemic changes, the bowel was fully pink after untwisting and no bowel needed to be resected. After untwisting, Ladd's bands were lysed, patency was demonstrated, and an appendectomy was performed. The baby was discharged on day-of-life 16 with full oral feeds and no complications.</p></div><div><h3>Conclusion</h3><p>Persistent bilious gastric output in the setting of extensive meconium-stained amniotic fluid is an uncommon presenting sign of fetal volvulus from malrotation. Prompt recognition is important to prevent bowel necrosis.</p></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213576624000460/pdfft?md5=6fcac3b4f0e10c184a95ce4bde6755c0&pid=1-s2.0-S2213576624000460-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Fetal volvulus presenting with In utero bilious emesis: A case report\",\"authors\":\"Felix Richter , Vanessa Eddy-Abrams , Harsha K. Garg , Peter S. Midulla , Veniamin Ratner\",\"doi\":\"10.1016/j.epsc.2024.102818\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>We report a case of fetal volvulus presenting with meconium-stained amniotic fluid, illustrating how meconium can mask <em>in utero</em> bilious emesis.</p></div><div><h3>Case presentation</h3><p>The male neonate was born at 37 + 1 weeks gestation via c-section for maternal indications and admitted to the Neonatal Intensive Care Unit for respiratory distress presumably due to meconium aspiration. However, an initial x-ray was not consistent with meconium aspiration syndrome. Overnight, the orogastric tube drained 173 mL of dark green-tinged fluid and the bilirubin was elevated at 8.2 (threshold 7.4), prompting phototherapy. Orogastric feeds were attempted but unsuccessful. The orogastric output was originally attributed to swallowed meconium. However, the large volume, bilious color, persistent output, unexplained respiratory distress, and elevated bilirubin prompted an upper GI series (UGIS). The UGIS was consistent with a proximal obstruction that was likely present from birth. The patient underwent exploratory laparotomy which revealed a volvulus from malrotation that was repaired with detorsion and Ladd procedure. Despite a dusky bowel suggestive of ischemic changes, the bowel was fully pink after untwisting and no bowel needed to be resected. After untwisting, Ladd's bands were lysed, patency was demonstrated, and an appendectomy was performed. The baby was discharged on day-of-life 16 with full oral feeds and no complications.</p></div><div><h3>Conclusion</h3><p>Persistent bilious gastric output in the setting of extensive meconium-stained amniotic fluid is an uncommon presenting sign of fetal volvulus from malrotation. 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引用次数: 0
摘要
导言我们报告了一例胎儿排气伴有胎粪染色羊水的病例,说明了胎粪是如何掩盖子宫内胆汁淤积性呕吐的。病例介绍这名男新生儿在妊娠 37+1 周时因母体原因剖腹产出生,因呼吸窘迫被送入新生儿重症监护室,推测原因是胎粪吸入。然而,最初的 X 光检查并不符合胎粪吸入综合征。一夜之间,口胃管排出 173 毫升深绿色液体,胆红素升高至 8.2(阈值 7.4),需要进行光疗。曾尝试口胃喂养,但未成功。口胃分泌物最初被认为是吞入的胎粪。然而,巨大的胃容量、胆汁颜色、持续的胃液排出、不明原因的呼吸困难和胆红素升高促使他接受了上消化道系列检查(UGIS)。上消化道穿刺检查结果显示,患者的近端梗阻很可能在出生时就已存在。患者接受了探查性开腹手术,结果发现肠旋转不良导致的肠管卷曲,并通过分离和拉德术进行了修复。尽管肠道呈暗色,提示有缺血性病变,但松开后肠道完全呈粉红色,无需切除肠道。松绑后,Ladd 带被溶解,显示出通畅,并进行了阑尾切除术。结论:在胎粪染色羊水广泛的情况下出现持续的胆汁性胃排出,是胎儿旋转不良引起胎儿肠旋转的一个不常见的表现。及时识别对防止肠坏死非常重要。
Fetal volvulus presenting with In utero bilious emesis: A case report
Introduction
We report a case of fetal volvulus presenting with meconium-stained amniotic fluid, illustrating how meconium can mask in utero bilious emesis.
Case presentation
The male neonate was born at 37 + 1 weeks gestation via c-section for maternal indications and admitted to the Neonatal Intensive Care Unit for respiratory distress presumably due to meconium aspiration. However, an initial x-ray was not consistent with meconium aspiration syndrome. Overnight, the orogastric tube drained 173 mL of dark green-tinged fluid and the bilirubin was elevated at 8.2 (threshold 7.4), prompting phototherapy. Orogastric feeds were attempted but unsuccessful. The orogastric output was originally attributed to swallowed meconium. However, the large volume, bilious color, persistent output, unexplained respiratory distress, and elevated bilirubin prompted an upper GI series (UGIS). The UGIS was consistent with a proximal obstruction that was likely present from birth. The patient underwent exploratory laparotomy which revealed a volvulus from malrotation that was repaired with detorsion and Ladd procedure. Despite a dusky bowel suggestive of ischemic changes, the bowel was fully pink after untwisting and no bowel needed to be resected. After untwisting, Ladd's bands were lysed, patency was demonstrated, and an appendectomy was performed. The baby was discharged on day-of-life 16 with full oral feeds and no complications.
Conclusion
Persistent bilious gastric output in the setting of extensive meconium-stained amniotic fluid is an uncommon presenting sign of fetal volvulus from malrotation. Prompt recognition is important to prevent bowel necrosis.