NECROTIZING ENTEROCOLITIS AND TWIN-TO-TWIN TRANSFUSION SYNDROME: A RARE CASE REPORT
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Tóm tắt
Overview: Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency in preterm infants. Twin-to-Twin Transfusion Syndrome (TTTS) represents a significant risk factor, particularly for the donor twin due to chronic intestinal hypoperfusion.
Case presentation: A male infant, born at 31 weeks 4 days, birth weight 900g, was the donor twin in a TTTS pregnancy. The patient presented with signs of bowel obstruction, abdominal distension, and bilious gastric residuals. Preoperative diagnosis suggested duodenal atresia. Intraoperative findings revealed a segment of focal necrotic bowel causing obstruction, 65cm from the Treitz ligament. Resection and end-to-end anastomosis were performed. Histopathology confirmed NEC with the presence of ganglion cells.
Discussion: This case illustrates the ischemic mechanism in donor twins leading to intestinal mucosal injury and necrosis, presenting as bowel obstruction rather than classic peritonitis.
Conclusion: A high index of suspicion for NEC is required in preterm donor twins of TTTS, even with atypical clinical and radiological presentations.
Chi tiết bài viết
Từ khóa
Necrotizing enterocolitis; Twin-to-twin transfusion syndrome; Donor twin, preterm; Neonatal intestinal obstruction.
Tài liệu tham khảo
2. Esposito F, Mamone R, Di Serafino M, et al. Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quantitative imaging in medicine and surgery. 2017;7(3):336 –354. 10.21037/qims.2017.03.01.
3. Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Multifetal Pregnancy. Williams Obstetrics, 26e. McGraw Hill; 2022:838-864.
4. Marwan AI, Zaretsky M, Feltis B. Complex multigestational anomalies. Elsevier; 2019:150825. https://doi.org/10.1053/j.sempedsurg.2019.07.008.
5. Rebai N, Lopriore E, Bekker V, Slaghekke F, Schoenaker MH, Groene SG. Necrotizing enterocolitis in monochorionic twins: insights from an identical twin model. Early Human Development. 2024;194:106052. https://doi.org/10.1016/j.earlhumdev.2024.106052.
6. Tran NN, Hutto S, Liu J, Bullock T, Virgilio R, Flowers DL. Necrotizing Enterocolitis in an Infant With a History of Twin-Twin Transfusion Syndrome: A Case Report. Cureus. 2024;16(3). 10.7759/cureus.56720.