Prenatal Diagnosis of Antenatal Midgut Volvulus: Specific Ultrasound Features

Objective:

The small bowel volvulus is a rare cause of intestinal obstruction which may occur in utero and whose prenatal diagnosis is difficult.Sonographic signs are mainly indirect and non specific.The aim of this study is to present a retrospective analysis of prenatal sonographicfindings in fetal segmental midgut volvulus.Thanks to this series the investigators could highlight the more specifics signs of the volvulus included a new pattern.

Study Overview

• Status: Completed
• Conditions: Fetal Volvulus; Midgut Volvulus
• Intervention / Treatment: Other: Fetal ultrasound during the second or third trimester/ Postnatal surgery / Post mortem examination

Detailed Description

Objective:

The small bowel volvulus is a rare cause of intestinal obstruction which may occur in utero and whose prenatal diagnosis is difficult. Sonographic signs are mainly indirect and nonspecific. The aim of this study is to present a retrospective analysis of prenatal sonographic findings in fetal segmental midgut volvulus. Thanks to this series the investigators could highlight the more specifics signs of the volvulus included a new pattern.

Methods:

Unicentric retrospective analysis of cases of prenatal midgut volvulus between 2006 and 2017. The primary inclusion criteria was postnatal diagnosis of prenatal volvulus based on post-natal findings and prenatal imaging findings. The exclusion criteria was the absence of prenatal imaging assessment. The investigators collected the clinical history and the echographic mode B and color Doppler. They have searched for some specific sign like " whirlpool sign " representing the winding of the mesenteric vein around the superior mesenteric arterywith color Doppler with arciform pattern of the midgut, hydro-meconium level in the dilated loops and position of mesenteric vessels for evaluation of the intestinal (mal) rotation. Gold standard was surgery or foetopathology if performed.

• Study Type: Observational
• Enrollment (Actual): 13

Contacts and Locations

Study Locations

• France
  • Montpellier, France, 34295
    • Uhmontpellier

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

• Sampling Method: Probability Sample

Study Population

All pregnant women

Description

Inclusion Criteria:

• postnatal diagnosis of prenatal volvulus based on post-natal findings and prenatal imaging findings

Exclusion Criteria:

• the absence of prenatal imaging assessment

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pregnant patients seen for second or third trimester; Foetus with diagnosis of prenatal volvulus based on post-natal findings and prenatal imaging findings	Other: Fetal ultrasound during the second or third trimester/ Postnatal surgery / Post mortem examination; Fetal ultrasound during the second or third trimester Postnatal surgery Post mortem examination

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
echography	Observation of specific signs using echography for the diagnosis of fetal during the second (22-24 weeks) and the third (31-34 weeks) trimester after ultrasound screening and when diagnostic ultrasound were performedmidgut volvulus	during the second (22-24 weeks) after ultrasound screening
echography	Observation of specific signs using echography for the diagnosis of fetal	the third (31-34 weeks) trimester after ultrasound screening

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ultrasound signs of complication	Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis.	the third (31-34 weeks) after ultrasound screening
ultrasound signs of complication	Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis.	during the second (22-24 weeks) after ultrasound screening
ultrasound signs of complication	Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis after diagnostic ultrasound.	1 day
ultrasound signs of complication	Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis.	just after delivery
presence or not of the volvulus	Observation of surgery outcome like presence or not of the volvulus after diagnostic ultrasound	1 day
presence or not of the volvulus	Observation of surgery outcome like presence or not of the volvulus	during the second (22-24 weeks) after ultrasound screening
presence or not of the volvulus	Observation of surgery outcome like presence or not of the volvulus	just after delivery
presence or not of the volvulus	Observation of surgery outcome like presence or not of the volvulus	the third (31-34 weeks) after ultrasound screening
presence or not ileal atresia.	Observation of surgery outcome like presence or not ileal atresia	during the second (22-24 weeks) after ultrasound screening
presence or not ileal atresia.	Observation of surgery outcome like presence or not ileal atresia	the third (31-34 weeks) after ultrasound screening
presence or not ileal atresia.	Observation of surgery outcome like presence or not ileal atresia	just after delivery
presence or not ileal atresia.	Observation of surgery outcome like presence or not ileal atresia after diagnostic ultrasound	1 day

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2006
• Primary Completion (ACTUAL): July 1, 2017
• Study Completion (ACTUAL): September 30, 2017

Study Registration Dates

• First Submitted: October 25, 2017
• First Submitted That Met QC Criteria: December 4, 2017
• First Posted (ACTUAL): December 5, 2017

Study Record Updates

• Last Update Posted (ACTUAL): December 5, 2017
• Last Update Submitted That Met QC Criteria: December 4, 2017
• Last Verified: October 1, 2017

More Information

Terms related to this study

• Keywords: Pregnant women; Midgut volvulus; Fetal volvulus; Whirlpool sign; Position of mesenteric vessels; Post natal surgery; Foetopathology if performed; Hydro-meconium level in the dilated loops
• Additional Relevant MeSH Terms: Digestive System Diseases; Congenital Abnormalities; Gastrointestinal Diseases; Intestinal Diseases; Pathological Conditions, Anatomical; Intestinal Obstruction; Torsion Abnormality; Digestive System Abnormalities; Intestinal Volvulus
• Other Study ID Numbers: RECHMPL17_0321

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No