2019 Volume 55 Issue 1 Pages 129-134
The patient was a 0-day-old girl who had shown a nonreassuring fetal status with decreased fetal movements at 35 weeks of gestation and a nonreassuring pattern on a cardiotocogram and a fetal intestinal dilatation in ultrasonography (US) at 36 weeks of gestation. After birth, her abdomen was markedly distended. Laboratory data showed leukocytosis, anemia, and metabolic acidosis. Contrast radiographic examination of the gastrointestinal series showed obstruction of the proximal jejunum without an intestinal malrotation, as well as the microcolon and narrow distal ileum. We suspected a strangulation ileus and performed emergent operation 4 hours after birth. The operation revealed that a part of the intestine with strangulation and volvulus incarcerated into the mesenteric defect, and that the grayish white meconium found in a congenital intestinal atresia had been filled in the distal ileum. The necrotic intestine was resected and the mesenteric defect was closed. She was discharged at 32 days of age. The microcolon and grayish white meconium found in this patient suggest that the herniation into the mesenteric defect of the intestine occurred before the middle gestation. The fetal distress and intestinal dilatation in late gestation suggest that a strangulated ileus with volvulus may have occurred in the fetus.
