Fetal volvulus: is emergency surgery the only option?-a single-center case series and management considerations

Fetal intestinal volvulus is a rare intrauterine condition associated with potentially severe neonatal morbidity. Owing to its rarity, diagnostic features and management strategies remain heterogeneous and are largely based on case reports and small case series.

We performed a retrospective single-center analysis of all patients diagnosed with intestinal volvulus between 2005 and 2022, comparing antenatally diagnosed fetal volvulus and postnatal presentation, diagnostic findings, management approaches, and outcomes. Given the rarity of fetal volvulus, the analysis was descriptive in nature.

45 patients with confirmed volvulus were analyzed, including seven fetal and 38 postnatal volvulus cases. Five fetal cases required postnatal surgical intervention, whereas two extremely preterm fetuses were managed conservatively with close prenatal surveillance and showed spontaneous regression of sonographic findings. Prenatal diagnosis relied mainly on ultrasound features, such as bowel distension and whirlpool sign. Outcomes in both groups were strongly influenced by gestational age and prematurity-related morbidity.

Fetal volvulus presents with heterogeneous clinical courses and requires individualized, multidisciplinary decision-making. Conservative observation may be considered in selected stable cases diagnosed at extreme prematurity, whereas at more advanced gestational ages, signs of fetal deterioration may prompt consideration of delivery and postnatal surgical management. Due to the limited cohort size, no standardized treatment recommendations can be derived.