Journal of Medical Case Reports 14, 123 (2020)

Intestinal volvulus in the pump twin of a twin-reversed arterial perfusion (TRAP) se-quence after laser therapy at 18 weeks: a case report.

Tania Herrera, Katia Rueda, Honorina Espinosa, Gabrielle B. Britton.

Abstract:

Background: Twin reversed arterial perfusion sequence is a rare and po-tentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually mani-festing after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin.

Case presentation: A 32-year-old Hispanic primigravida was referred to our

clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical “whirlpool sign” at 26 weeks of gestation, and intra-uterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean sec-tion was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology.

Conclusions: The type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnancies.