Neonatal Med.  2021 Feb;28(1):53-58. 10.5385/nm.2021.28.1.53.

A Case of Midgut Volvulus with Gastric Perforation and Periveintricular Leukomalacia in a Term Infant

• Park SG
• Hwang JH

• KMID: 2513360
• DOI: http://doi.org/10.5385/nm.2021.28.1.53

Abstract

Intestinal malrotation with midgut volvulus (MV) is a life-threatening surgical emergency. Most events of MV occur in the neonatal period with bilious vomiting, abdominal distension, feeding intolerance, and bloody stools. Neonatal gastric perforation (GP) is a rare and life-threatening condition associated with high mortality. It occurs either in an idiopathic form or in association with gastrointestinal anomalies such as duodenal atresia and MV. The pathogenesis of both MV and GP is related to ischemic change and inflammatory response. MV and GP can lead to morbidities such as sepsis, intestinal ischemia, and organ failure, but not neurologic problems. We herein report the case of a term infant at 5 days after birth, with MV accompanied by GP, who developed periventricular leukomalacia.

Keyword

Intestinal volvulus; Stomach; Intestinal perforation; Leukomalacia, periventricular; Infant

Figure

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  Figure 1. Abdominal radiograph shows pneumoperitoneum (A) and the absence of distal gas (B) at 5 days after birth.

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  Figure 2. Enhanced abdominal computer tomography at 5 days after birth shows (A) pneumohemoperitoneum with perforation of the fundus of stomach (green arrow); (B) the superior mesenteric vein (blue arrow) located to the left of the superior mesenteric artery (red arrow); the decrease in hepatic (C) and renal (D) perfusion along with multifocal hypoattenuated lesions (yellow arrows) indicated an ischemic infarction.

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  Figure 3. Intraoperative images show (A) the rupture of the fundus of stomach (blue circle); (B) Ladd bands running across the duodenum to the terminal ileum and cecum located in the left abdomen (blue circle).

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  Figure 4. (A) Brain magnetic resonance imaging (MRI) findings at 28 days after birth show cystic changes of the periventricular white matter in both frontal lobes (sky-blue arrow). The thinning of the corpus callosum (B) and the wavy wall of both lateral ventricles (red arrow) (C) are demonstrated on the brain MRI at 12 months.

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