A Rare Case of Antenatal Intestinal Perforation on Top of Primary Volvulus in a Newborn with Congenital CMV

Gastrointestinal perforation during neonatal life is a common condition, carrying a mortality of 17–60%. But antenatal intestinal perforation due to volvulus is a rare condition. Intestinal volvulus is commonly associated with malrotation or atresia. A primary small bowel volvulus is extremely rare. It is a rare but life threatening surgical emergency manifesting after birth and as such rarely diagnosed prenatally. It causes intestinal obstruction and perforation, leading to a sterile chemical peritonitis. The usual site of perforation is the small bowel, the distal ileum being the most frequent site. On the other hand, gastrointestinal involvement in congenital or perinatal CMV infection is infrequent. We present here the case of a preterm baby born with distended, tensed abdomen and bluish discoloration around the umbilicus. CT-scan of abdomen showed presence of large cystic lesion. Exploratory laparotomy showed intestinal obstruction due to volvulus with necrosis of the ileum and perforation causing meconium peritonitis. Also the baby was diagnosed with congenital CMV and received the appropriate treatment. Intestinal perforation rarely occur antenatal, and intestinal volvulus causing perforation usually occurs on top of malrotation. To add to, congenital CMV rarely causes gastrointestinal manifestations.