CASE REPORT article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
Volume 13 - 2025 | doi: 10.3389/fped.2025.1586328
Ultrasound "Whirlpool Sign" in Fetal Intestinal Malrotation and Torsion: A Case-Based Approach to Early Diagnosis and Intervention
Provisionally accepted
- 1The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- 2Shandong First Medical University, Jinan, China
- 3Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Introduction: Fetal ascites is a rare condition that may indicate underlying gastrointestinal malformations, including congenital intestinal malrotation. Early recognition and timely intervention are crucial to prevent complications such as intestinal torsion and ischemic necrosis.This study reports a case of fetal intestinal malrotation presenting with isolated ascites and acute fetal distress, emphasizing the role of ultrasound and multidisciplinary management in improving neonatal outcomes.Case Report: A late-term fetus presented with reduced fetal movements. Ultrasound revealed moderate ascites, bowel dilation, and the characteristic "whirlpool sign," suggesting intestinal malrotation with volvulus. Doppler ultrasound indicated abnormal umbilical artery blood flow, and cardiotocography (CTG) confirmed fetal distress. An emergency cesarean section was performed after a multidisciplinary consultation. Intraoperative findings revealed intestinal volvulus, and postoperative evaluation confirmed ischemic necrosis. The neonate underwent abdominal paracentesis and received comprehensive treatment, including respiratory support, antimicrobial therapy, and nutritional management. Histopathological examination confirmed localized intestinal necrosis without perforation. The infant recovered well and was discharged in stable condition.Fetal ascites may be an early sign of congenital intestinal malrotation and volvulus.The ultrasound "whirlpool sign" indicates intestinal malrotation and possible volvulus, aiding early detection but not confirming bowel necrosis. Prompt multidisciplinary decision-making is essential to improve perinatal outcomes and prevent severe complications.
Keywords: Fetal ascites, Intestinal malrotation, Volvulus, ultrasound whirlpool sign, Fetal Distress, Perinatal management
Received: 05 Mar 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Liu, Zheng, Liu and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zonghua Liu, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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