ULTRASOUND Messages for January, 2002: Re: Fetal volvulus?

Re: Fetal volvulus?
From: zalel (zalel_y@netvision.net.il)
Sat Jan 5 16:10:01 2002

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How were the kidneys and ureters? This could be an urinoma! What is the gender of the fetus?
An interesting case
Yaron Zalel, MD
> ----- Original Message -----
From: BUCHHAVE PER To: Multiple recipients of list ULTRASOUND Sent: Saturday, January 05, 2002 8:25 PM Subject: Fetal volvulus?
Hello!
Have got a patient with infertility problems, who got pregnant spontaneusly. At her first ultrasound at 16 compl.weeks the baby had a cyst intraabdominally in front and over the fetal bladder with size about the size of the bladder. The cyst had som minor dense content, but was otherwise sonolucent. 3 weeks later there were several cysts with the same character, but I got the feeling that it was dilated intestines with content and quite heavy peristaltic. There were a tendency towards oligohydramnios, but else the fetus seemed ok.
2 weeks later this picture had changed totally. The cysts had barely disappeared, a moderat amount of ascites had come instead and the oligohydramnios remained.
2 weeks later (week 25) the baby is still alive, but the ascites is enormeous. Oligohydramnios is the same and blood flow in the umbilical cord is normal.
My guess is that it is a volvulus with rupture of the intestines, but I am surprised, that the fetus has survived so long time.
Is there any other diff.diagnosis and possible treatment option?
Per K. Buchhave
Sen.consultant, Karlskrona, Sweden
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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML xmlns="http://www.w3.org/TR/REC-html40" xmlns:o "urn:schemas-microsoft-com:office:office" xmlns:w "urn:schemas-microsoft-com:office:word"><HEAD> <META http-equiv=Content-Type content="text/html; charset=Windows-1252"> <META content=Word.Document name=ProgId> <META content="MSHTML 5.50.4134.600" name=GENERATOR> <META content="Microsoft Word 10" name=Originator><LINK href="cid:filelist.xml@01C1961E.98C7C9E0" rel=File-List> <STYLE>@page Section1 {size: 595.3pt 841.9pt; margin: 70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin: 36.0pt; mso-footer-margin: 36.0pt; mso-paper-source: 0; } P.MsoNormal { FONT-SIZE: 12pt; MARGIN: 0cm 0cm 0pt; FONT-FAMILY: "Times New Roman"; mso-style-parent: ""; mso-pagination: widow-orphan; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman" } LI.MsoNormal { FONT-SIZE: 12pt; MARGIN: 0cm 0cm 0pt; FONT-FAMILY: "Times New Roman"; mso-style-parent: ""; mso-pagination: widow-orphan; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman" } DIV.MsoNormal { FONT-SIZE: 12pt; MARGIN: 0cm 0cm 0pt; FONT-FAMILY: "Times New Roman"; mso-style-parent: ""; mso-pagination: widow-orphan; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman" } A:link { COLOR: blue; TEXT-DECORATION: underline; text-underline: single } SPAN.MsoHyperlink { COLOR: blue; TEXT-DECORATION: underline; text-underline: single } A:visited { COLOR: purple; TEXT-DECORATION: underline; text-underline: single } SPAN.MsoHyperlinkFollowed { COLOR: purple; TEXT-DECORATION: underline; text-underline: single } SPAN.E-postmall17 { COLOR: windowtext; FONT-FAMILY: Arial; mso-bidi-font-size: 10.0pt; mso-style-type: personal-compose; mso-style-noshow: yes; mso-ansi-font-size: 10.0pt; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial; mso-bidi-font-family: Arial } SPAN.SpellE { mso-style-name: ""; mso-spl-e: yes } SPAN.GramE { mso-style-name: ""; mso-gram-e: yes } DIV.Section1 { page: Section1 } </STYLE> </HEAD> <BODY lang=SV style="tab-interval: 65.2pt" vLink=purple link=blue bgColor=#ffffff> <DIV><FONT face="Arial (hebrew)" size=2>How were the kidneys and ureters? This could be an urinoma!</FONT></DIV> <DIV><FONT size=2>What is the gender of the fetus?</FONT></DIV> <DIV><FONT size=2></FONT> </DIV> <DIV><FONT size=2>An interesting case</FONT></DIV> <DIV><FONT size=2></FONT> </DIV> <DIV><FONT size=2>Yaron Zalel, MD</FONT></DIV> <BLOCKQUOTE dir=ltr style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
> <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> <A title=buchhave.per@telia.com href="mailto:buchhave.per@telia.com">BUCHHAVE PER</A> </DIV> <DIV style="FONT: 10pt arial"><B>To:</B> <A title=ultrasound@mail.medispecialty.com href="mailto:ultrasound@mail.medispecialty.com">Multiple recipients of list ULTRASOUND</A> </DIV> <DIV style="FONT: 10pt arial"><B>Sent:</B> Saturday, January 05, 2002 8:25 PM</DIV> <DIV style="FONT: 10pt arial"><B>Subject:</B> Fetal volvulus?</DIV> <DIV><BR></DIV> <DIV class=Section1> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">Hello!<o:p></o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">Have got a patient with infertility problems, <SPAN class=GramE>who</SPAN> got pregnant <SPAN class=SpellE>spontaneusly</SPAN>. <SPAN style="mso-spacerun: yes"> </SPAN>At her first ultrasound <SPAN class=GramE>at 16 <SPAN class=SpellE>compl.weeks</SPAN></SPAN> the baby had a cyst <SPAN class=SpellE>intraabdominally</SPAN> in front and over the <SPAN class=SpellE>fetal</SPAN> bladder with size about the size of the bladder. <SPAN style="mso-spacerun: yes"> </SPAN>The cyst had <SPAN class=SpellE>som</SPAN> minor dense content, but was otherwise <SPAN class=SpellE>sonolucent</SPAN>.<SPAN style="mso-spacerun: yes">  </SPAN>3 weeks later there were several cysts with the same character, but I got the feeling that it was dilated intestines with content and quite heavy peristaltic. <SPAN style="mso-spacerun: yes"> </SPAN>There were a tendency towards oligohydramnios, but else the <SPAN class=SpellE>fetus</SPAN> seemed ok.<SPAN style="mso-spacerun: yes">  </SPAN><o:p></o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">2 weeks later this picture had changed totally. <SPAN style="mso-spacerun: yes"> </SPAN>The cysts had barely disappeared<SPAN class=GramE>, <SPAN style="mso-spacerun: yes"> </SPAN>a</SPAN> <SPAN class=SpellE>moderat</SPAN> amount of <SPAN class=SpellE>ascites</SPAN> had come instead and the oligohydramnios remained.<SPAN style="mso-spacerun: yes">   </SPAN><o:p></o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">2 weeks later (week 25) the baby is still alive, but the <SPAN class=SpellE>ascites</SPAN> is <SPAN class=SpellE>enormeous</SPAN>.<SPAN style="mso-spacerun: yes">  </SPAN>Oligohydramnios is the same and blood flow in the umbilical cord is normal. <o:p></o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">My guess is that it is a <SPAN class=SpellE>volvulus</SPAN> with rupture of the intestines, but I am surprised, that the <SPAN class=SpellE>fetus</SPAN> has survived so long time.<o:p></o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">Is there any other <SPAN class=SpellE>diff.diagnosis</SPAN> and possible treatment option?<o:p></o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB"><o:p> </o:p></SPAN></FONT></P> <P class=MsoNormal><FONT face="Times New Roman" size=3><SPAN style="FONT-SIZE: 12pt"><SPAN style="mso-bidi-font-size: 10.0pt">Per K. Buchhave<o:p></o:p></SPAN></SPAN></FONT></P> <P class=MsoNormal><SPAN class=SpellE><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">Sen.consultant</SPAN></FONT></SPAN><FONT face=Arial size=2><SPAN lang=EN-GB style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-ansi-language: EN-GB">, <SPAN class=SpellE>Karlskrona</SPAN>, Sweden<o:p></o:p></SPAN></FONT></P></DIV></BLOCKQUOTE></BODY></HTML>
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