An Unusual Case of Malrotation in a Baby Conceived by In vitro Fertilization

Caroline Pardy

doi:10.15406/jpnc.2014.01.00033

Abstract

Introduction: Interruption of intestinal rotation and fixation during any point in the development of the midgut results in an anatomic spectrum encompassed by the term 'malrotation'. Case presentation: We present an unusual variant of malrotation in a neonate conceived by In vitro fertilization. Discussion: Assisted reproductive techniques have been recognized to be associated with a higher risk of congenital anomalies. However, there have been inconsistent reports regarding an increased risk of gastrointestinal anomalies. Recent reports have also linked assisted reproductive techniques to an increased risk of genetic imprinting disorders. There is evidence to suggest that some cases of malrotation may have a genetic aetiology. The fact that the case presented was conceived by In vitro fertilization may be entirely incidental, however the unusual bowel orientation has led us to speculate whether assisted reproductive techniques might be associated with rarer forms of malrotation.

Highlights

Interruption of intestinal rotation and fixation during any point in the development of the midgut results in an anatomic spectrum encompassed by the term ‘malrotation’.Case presentation: We present an unusual variant of malrotation in a neonate conceived by In vitro fertilization
Internal hernias are recognized as a rare feature of some forms of malrotation
When the ascending colon becomes fixed to the retroperitoneum, the small bowel loops become trapped behind the mesentery

Summary

Discussion

Internal hernias are recognized as a rare feature of some forms of malrotation. Left and right paraduodenal hernias are the most common recognized internal hernias, with left being more common than right [4]. A Swedish study of congenital malformations associated with IVF observed an increased risk of oesophageal atresia, small bowel and anal atresia, in their data analyzed from 1982-2001 [7]. This case emphasizes the broad spectrum of abnormal bowel rotation encompassed by the term ‘malrotation’, and the need for the surgeon to adapt their approach to definitive management when faced with such challenging cases. The fact that this baby was conceived by assisted reproduction may be coincidental, it should raise awareness that unusual forms of malrotation may be observed with the increased use of assisted reproductive techniques

Introduction