Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 7, 2008; 14(9): 1456-1458
Published online Mar 7, 2008. doi: 10.3748/wjg.14.1456
Intrauterine midgut volvulus without malrotation: Diagnosis from the ‘coffee bean sign’
Jun Seok Park, Seong Jae Cha, Beom Gyu Kim, Yong Seok Kim, Yoo Shin Choi, In Taik Chang, Gwang Jun Kim, Woo Seok Lee, Gi Hyeon Kim
Jun Seok Park, Seong Jae Cha, Beom Gyu Kim, Yong Seok Kim, Yoo Shin Choi, In Taik Chang, Department of Surgery, College of Medicine, Chung-Ang University, Seoul 156-755, Korea
Gwang Jun Kim, Woo Seok Lee, Department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University, Korea
Gi Hyeon Kim, Department of Radiology, College of Medicine, Chung-Ang University, Seoul 156-755, Korea
Correspondence to: Seong Jae Cha, MD, Professor, Department of Surgery, College of Medicine, Chung-Ang University, 224-1 Heukseok-Dong, Dongjak-Gu, Seoul 156-755, Korea. jwas@naver.com
Telephone: +82-2-62991548
Fax: +82-2-8247869
Received: October 30, 2007
Revised: December 9, 2007
Published online: March 7, 2008
Abstract

Fetal midgut volvulus is quite rare, and most cases are associated with abnormalities of intestinal rotation or fixation. We report a case of midgut volvulus without malrotation, associated with a meconium pellet, during the gestation period. This 2.79 kg, 33-wk infant was born via a spontaneous vaginal delivery caused by preterm labor. Prenatal ultrasound showed dilated bowel loops with the appearance of a ‘coffee bean sign’. This patient had an unusual presentation with a distended abdomen showing skin discoloration. An emergency laparotomy revealed a midgut volvulus and a twisted small bowel, caused by complicated meconium ileus. Such nonspecific prenatal radiological signs and a low index of suspicion of a volvulus during gestation might delay appropriate surgical management and result in ischemic necrosis of the bowel. Preterm labor, specific prenatal sonographic findings (for example, the coffee bean sign) and bluish discoloration of the abdominal wall could suggest intrauterine midgut volvulus requiring prompt surgical intervention.

Keywords: Midgut volvulus; Coffee bean sign; Meconium ileus