Isolated Ascites in a Monochorionic Twin after Fetoscopic Laser Ablation Is Not Necessarily Secondary to Recurrence or Anaemia: Bowel Complications in Twin-to-Twin Transfusion Syndrome after Fetoscopic Laser Ablation

Fetal Diagn Ther. 2019;45(5):285-294. doi: 10.1159/000494616. Epub 2018 Dec 14.


Background/purpose: We report a case study of jejunal atresia and the results of a systematic literature review of all reported cases of bowel complications occurring after fetoscopic laser ablation (FLA) for the treatment of twin-to-twin transfusion syndrome (TTTS).

Methods: A systematic literature review was performed of bowel complications after FLA for TTTS according to PRISMA guidelines.

Results: There are 11 published cases of small bowel atresia, 5 cases of necrotising enterocolitis (NEC), and 2 cases with foetal bowel perforations. Recipient twins were more likely to be affected by small bowel atresia (7 recipient and 4 donor cases) and NEC (3 recipient and 2 donor twins). Prenatal ultrasonographic abnormalities were demonstrated in 7 out of 9 cases with bowel atresia and in both cases of bowel perforation. The overall survival rate for neonates with bowel complications after FLA is 72%, but is much lower for co-twins at 22%. The survival rates for jejunoileal atresia and NEC are 91 and 40%, respectively.

Conclusions: It is uncertain as to whether these bowel anomalies are due to bowel ischaemia associated with TTTS, the treatment with FLA, or a combination of both. Cases with prenatal abdominal ultrasonographic abnormalities after FLA should have close prenatal and postnatal assessment to detect bowel complications.

Keywords: Bowel perforation; Fetoscopic laser ablation; Ileal atresia; Jejunal atresia; Necrotising enterocolitis; Twin-to-twin transfusion syndrome.

Publication types

  • Case Reports
  • Systematic Review

MeSH terms

  • Adult
  • Anemia / diagnostic imaging*
  • Anemia / surgery
  • Ascites / diagnostic imaging*
  • Ascites / surgery
  • Chorion / diagnostic imaging
  • Chorion / surgery
  • Female
  • Fetal Death
  • Fetofetal Transfusion / diagnostic imaging*
  • Fetofetal Transfusion / surgery
  • Fetoscopy / adverse effects
  • Fetoscopy / methods*
  • Humans
  • Infant, Newborn
  • Intestinal Atresia / diagnostic imaging*
  • Intestinal Atresia / surgery
  • Laser Therapy / adverse effects
  • Laser Therapy / methods*
  • Pregnancy
  • Pregnancy, Twin
  • Recurrence