Olivier Prodhomme MD, Abstract Co-Author: Nothing to Disclose

Magali Saguintaah MD, Presenter: Nothing to Disclose

Catherine Baud MD, Abstract Co-Author: Nothing to Disclose

Nancy Bechard-Sevette MD, Abstract Co-Author: Nothing to Disclose

Julie Bolivar-Perrin, Abstract Co-Author: Nothing to Disclose

Stephanie David MD, Abstract Co-Author: Nothing to Disclose

Alain Couture MD, Abstract Co-Author: Nothing to Disclose

To present 8 cases of fetal intestinal volvulus and their outcome. To discuss their etiologies. To describe a specific sign of volvulus on MRI. To discuss the contribution of MRI to the diagnosis and prognosis in comparison with ultrasonography.

Between 2006 and 2013, 8 cases of fetal intestinal volvulus were diagnosed in our institution. The term of diagnosis ranged from 25 to 33 weeks of gestation. We retrospectively studied their clinical, ultrasonographic and MRI data. MRI was performed on a 1.5 T device with T1 and T2 weighted axial, coronal and sagittal sequences. The volvulus was confirmed in 7 cases by surgery or foetopathology.

The main clinical abnormality was a decrease in fetal mobility (7). The volvulus was diagnosed on ultrasound in 2 cases by showing the whirlpool sign. It was suspected in 1 (bowel distension with hydrohydric level, ascitis). A hydrohydric level was recognized afterwards in 4 more cases. The diagnosis was established on MRI in all cases, with: - Snail sign in 8: direct visualization of spiraled bowel loops, at best in coronal planes and on T1W sequences, with hyper signal of bowel content on T1W (8) and T2W (7) sequences - Hydrohydric level: 3 In all cases MRI allowed to better evaluate the amount of normal bowel loops. Associated abnormalities included a laparoschisis (1), cystic fibrosis (2), small bowel atresia (3), localized mesenteric fusion (in 2 twins). No midgut malrotation was present. The outcome was favorable in 5 cases after neonatal surgery. In 1 case, urgent cesarean section was realized at 33 weeks of gestation because of fetal bradycardia. The newborn died shortly after birth because of an associated huge meconial pseudocyst compromising the ventilation. 2 fetuses with cystic fibrosis were interrupted.  

MRI is a reliable tool for the diagnosis of fetal midgut volvulus. The snail sign is constantly present in our series and easy to assess. MRI helps to determine the amount of normal bowel and thereby the evaluation of prognosis.

Fetal midgut volvulus is rare. Its prognosis seems good if not associated with cystic fibrosis. An early diagnosis allows to improve prenatal follow-up, parents information, neonatal management.

Prodhomme, O, Saguintaah, M, Baud, C, Bechard-Sevette, N, Bolivar-Perrin, J, David, S, Couture, A, The Snail Sign in Prenatal Intestinal Volvulus: A Specific Semiology on Fetal MRI in 8 Cases.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018362.html