Prenatal double bubble with distal fluid: Not a marker for malrotation with volvulus.
L’essentiel
BackgroundThe prenatal "double bubble" (DB) sign is a marker of duodenal obstruction. When accompanied by distal bowel fluid on prenatal imaging, concern may arise for malrotation with volvulus. This study evaluated whether distal bowel fluid in fetuses with a prenatal DB sign is associated with malrotation or volvulus.MethodsWe performed an 11-year retrospective review (Jan 2015-Dec 2025) of fetuses with a prenatal DB sign evaluated at a single tertiary care center. Prenatal ultrasound and fetal MRI findings, operative diagnoses, and neonatal outcomes were reviewed, with specific attention to distal bowel fluid on fetal MRI.ResultsTwenty-nine fetuses were identified. Median gestational age at birth was 37.5 weeks (IQR 34.5-38.0), and polyhydramnios was present in 62.1%. Fetal MRI was performed in 10 cases, demonstrating distal bowel fluid in 5. No prenatal imaging suggested volvulus. Among 27 neonates undergoing surgery, duodenal obstruction was confirmed in 25 (93.8%). Asymptomatic malrotation was identified in 5 infants, and no cases of prenatal or postnatal midgut volvulus occurred. One-year survival was 100%.ConclusionsPrenatal DB is a highly sensitive marker of duodenal obstruction. Distal bowel fluid on fetal MRI was not associated with malrotation with volvulus, supporting reassurance during prenatal counseling.
Synthèse détaillée
Résumé original
BackgroundThe prenatal "double bubble" (DB) sign is a marker of duodenal obstruction. When accompanied by distal bowel fluid on prenatal imaging, concern may arise for malrotation with volvulus. This study evaluated whether distal bowel fluid in fetuses with a prenatal DB sign is associated with malrotation or volvulus.MethodsWe performed an 11-year retrospective review (Jan 2015-Dec 2025) of fetuses with a prenatal DB sign evaluated at a single tertiary care center. Prenatal ultrasound and fetal MRI findings, operative diagnoses, and neonatal outcomes were reviewed, with specific attention to distal bowel fluid on fetal MRI.ResultsTwenty-nine fetuses were identified. Median gestational age at birth was 37.5 weeks (IQR 34.5-38.0), and polyhydramnios was present in 62.1%. Fetal MRI was performed in 10 cases, demonstrating distal bowel fluid in 5. No prenatal imaging suggested volvulus. Among 27 neonates undergoing surgery, duodenal obstruction was confirmed in 25 (93.8%). Asymptomatic malrotation was identified in 5 infants, and no cases of prenatal or postnatal midgut volvulus occurred. One-year survival was 100%.ConclusionsPrenatal DB is a highly sensitive marker of duodenal obstruction. Distal bowel fluid on fetal MRI was not associated with malrotation with volvulus, supporting reassurance during prenatal counseling.