Intrauterine midgut volvulus without malrotation: Diagnosis from the ‘coffee bean sign’

Figure 1 A fetal sonogram showing dilated bowel loops with the appearance of a ‘coffee bean sign’. No ascites was seen in the fetal abdomen.

Figure 2 A: Pre-operative infantogram showing a gas shadow only in the stomach, with an absence of any distal gas shadow; B: Unenhanced abdominal CT showed meconium (arrow) in the distal small bowel, with mild fluid distension of the proximal small bowel.

Figure 3 On laparotomy, the infant was found to have a midgut volvulus with necrosis and perforation of the small bowel. The small bowel was found to be twisted at the level of the narrow meconium-filled distal ileum (arrow).