Division of Neonatology, Children’s Hospital of Eastern Ontario, Canada
Faculty of Medicine, University of Ottawa, Canada
Department of Pediatrics, Children’s Hospital of Eastern Ontario, Canada
Department of Medical Imaging, Children’s Hospital of Eastern Ontario, Canada
Faculty of Health Sciences, Western University, Canada
Department of Surgery, Children’s Hospital of Eastern Ontario, Canada
Address for correspondence: Gregory P. Moore, MD, FRCPC, The Ottawa Hospital – General Campus, Division of Newborn Services – Box 806, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Tel.: +1 613 737 8561; Fax: +1 613737 8889; E-mail: [email protected].
Abstract: Intrauterine intestinal obstruction complicated by midgut volvulus is a serious life-threatening diagnosis. Immediate surgical intervention is generally the course of action upon diagnosis to prevent morbidity and mortality. We report a case of intrauterine intestinal obstruction where the neonate then presented with an unusual onset of volvulus within the first 12 hours of life. The patient was born with generalized edema, a distended abdomen, and pallor. Unlike many cases, the patient did not present with typical signs of volvulus. Diagnostic imaging preceding delivery and the stable postnatal clinical course did not offer a justification for immediate laparotomy. Less than 24 hours later, the patient’s hemoglobin significantly dropped leading to an emergent laparotomy. Findings included a volvulus of the terminal ileum and large amounts of intraluminal blood. Our case report includes an analysis of clinical observations that should be considered so that patients presenting with similar signs receive earlier surgical intervention.