Prenatal diagnosis of isolated bowel malrotation and its impact on post-natal management. A case report and review of the literature

Introduction: Intestinal rotation anomalies (IRA) involve a spectrum of congenital defects of bowel rotation and fixation arising in the prenatal period. They may predispose to life-threatening conditions such as severe obstruction or midgut volvulus. We present a case of prenatal diagnosis of isolated IRA and discuss the implications on postnatal management. Case presentation: Inversion of mesenteric vessels and colon misplacement in the left abdomen was found at routine 3rd trimester US in a 30 y.o. healthy woman. Prenatal MRI showed colon in the left and small bowel in the right and central abdomen. Postnatal GI contrast study was compatible with intestinal non-rotation with the cecum high in the left abdomen, which was confirmed at surgery. Post-operative course was uneventful. The patient is in good clinical conditions, thriving well, with no reported problems at follow-up. Conclusions: Abnormal bowel rotation may be detected prenatally also in the absence of US signs of congenital anomalies that are typically associated with IRA or related complications. When intestinal malrotation is suspected, prenatal US and fetal MRI may help guiding postnatal management, eventually allowing prompt surgical management to prevent midgut volvulus.