Tube ileostomy technique successfully preserved the ileocecal region in a case of fetal intestinal volvulus without malrotation: A case report

TL;DR

A tube ileostomy helped preserve the ileocecal valve in a rare fetal intestinal volvulus case, supporting the neonate's growth and recovery.

Contribution

Demonstrates successful valve preservation using tube ileostomy in a rare neonatal condition with delayed anastomosis.

Findings

Tube ileostomy preserved the ileocecal valve and supported growth in a neonate with intestinal volvulus.

Stool recycling and parenteral nutrition improved weight gain during delayed anastomosis.

Prenatal ultrasound detection enabled timely surgical intervention.

Abstract

Preserving the ileocecal valve in terminal ileal necrosis is crucial to prevent bile acid malabsorption and growth impairment. Fetal intestinal volvulus without malrotation (IVWM) is rare. This report highlights successful valve preservation via tube ileostomy in a neonate with IVWM, offering practical insight into neonatal bowel management.

A male neonate was delivered by emergency cesarean section at 37 weeks due to antenatal bowel dilation. A whirlpool sign on ultrasound prompted laparotomy, revealing a 1080-degree volvulus 2 cm distal to the ileocecal valve without malrotation. Thirty-two centimeters of necrotic ileum were resected. Due to inflammation, anastomosis was not feasible; an end ileostomy and distal tube ileostomy were performed, preserving 55 cm of proximal bowel and 2 cm distal to the valve. Weight gain improved following parenteral nutrition and stool recycling. Contrast study on day 53 confirmed distal patency, and reanastomosis was completed on day 94. The patient was discharged 47 days later.

When immediate anastomosis is not feasible, distal closure is often chosen. This case shows that tube ileostomy with stool recycling can preserve function even with minimal distal ileum, supporting growth and adaptation.

Tube ileostomy enabled valve preservation and a favorable outcome.

Unlabelled Image

•Tube ileostomy is valuable when anastomosis must be delayed.•Stool recycling supports nutritional recovery.•Prenatal ultrasound aids early detection and intervention in fetal volvulus.

Tube ileostomy is valuable when anastomosis must be delayed.

Stool recycling supports nutritional recovery.

Prenatal ultrasound aids early detection and intervention in fetal volvulus.

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