PMC5688350_01
Mildly dilated small bowel with thickened and hyperechogenic intestinal wall (a) in a typical whirlpool configuration (a, b). Aggravation of intestinal dilatation (c) and peritoneal calcifications leading to the suspicion of meconium peritonitis (d).
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There was a typical whirlpool configuration of the bowel (Figure 1). Ultrasound follow-up at 36 weeks and 4 days of gestation revealed a significant aggravation of intestinal dilatation (30 mm) appearing more extensively with persistent intestinal peristalsis, and some parietal calcifications appeared with a meconium pseudocyst but there were no ascites (Figure 1).
Postnatal plain abdominal X-ray showing a voluminous dilated bowel loop (a). Water-soluble contrast enema with opacification of a few centimeters of the last ileal loop (b).
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The postnatal plain abdominal X-ray showed a voluminous dilated bowel loop (Figure 2). The water-soluble contrast enema revealed a vacuous colon in normal position, a caecum in the right iliac fossa, and an opacification of a few centimeters of the last ileal loop (Figure 2).
Small bowel atresia with dilated small bowel five centimeters above ileocaecal valve (a). Volvulus loop resected (b) and 16 cm of dilated small bowel resected (c).
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A right transverse laparotomy was performed the day after birth and revealed a segmental small bowel volvulus with a perforated meconium pseudocyst secondary to in utero perforation of distal ileum and a type II small bowel atresia five centimeters above ileocaecal valve (Figure 3). Given the significant difference in the diameter of the two loops, the distal loop was opened on its antimesenteric side to realize a termino-terminal ileoileal anastomosis more congruent without perioperative complication (Figure 3).