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Early recognition enabled timely delivery and prompt surgical treatment, resulting in an uneventful recovery and sustained health at 3-year follow-up.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/prenatal-mri-detection-of-fetal-small-intestinal-volvulus-the-black-and-white-and-coffee-bean-signs/407333/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/prenatal-mri-detection-of-fetal-small-intestinal-volvulus-the-black-and-white-and-coffee-bean-signs/407333.png","ImageObject",300,407,{"name":92,"@type":93},"Levi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was fetal MRI performed in this case?","Question",{"text":113,"@type":114},"Ultrasound showed fetal ascites and dilated intestines, but the cause was unclear. MRI was used to differentiate volvulus from other possibilities such as intestinal atresia, meconium peritonitis, and bowel obstruction.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What MRI signs supported the diagnosis of small intestinal volvulus?",{"text":118,"@type":114},"Fetal MRI showed a low T2 signal in dilated intestines (“black-and-white sign”) and adjacent thickened oval loops suggesting torsion (“coffee-bean sign”).",{"name":120,"@type":111,"acceptedAnswer":121},"How did the prenatal diagnosis affect management and outcome?",{"text":122,"@type":114},"Emergency cesarean delivery was performed at 33 weeks, followed by laparotomy 3 hours after birth. Segmental resection confirmed twisted necrotic intestine, with an uneventful postoperative course and health maintained at 3-year follow-up.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},407333,1791304459,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},7971461740909,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Clinical Case Reports  \nCASE IMAGE  OPEN ACCESS   \nPrenatal MRI Detection of Fetal Small Intestinal Volvulus: The Black-and-White and Coffee-Bean Signs  \nMiyu Nakamura | Hiroshi Sato  | Kazuyo Kakui  \nDepartment of Obstetrics and Gynecology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan Correspondence: Hiroshi Sato ([shiro801219@yahoo.co.jp](shiro801219@yahoo.co.jp))  \nReceived: 6 June 2025 | Revised: 23 October 2025 | Accepted: 21 December 2025  \nKeywords: fetal intestinal volvulus | fetal MRI | neonatal surgery | prenatal diagnosis | small bowel obstruction  \nABSTRACT  \nA rare case of fetal small intestinal volvulus was diagnosed prenatally using MRI, with characteristic black-and-white and coffeebean signs. Early diagnosis led to timely surgical intervention and a favorable outcome.  \n1 | Case Description  \nA 35-year-old Japanese woman presented with decreased fetal movement at 33 weeks. Ultrasound revealed fetal ascites and dilated intestinal tract. Because the cause of fetal ascites and bowel dilatation was uncertain on ultrasound, fetal MRI was  \nperformed to differentiate volvulus from intestinal atresia, meconium peritonitis, or bowel obstruction. Fetal MRI demonstrated characteristic findings: low T2 signal in dilated intestines (Figure 1A, “black-and-white sign”) and adjacent thickened oval loops suggesting torsion (Figure 1B, “coffee-bean sign”) . Emergency cesarean section was performed at 33 weeks, and the  \nFIGURE 1 | (A) Fetal MRI (T2-weighted image) shows low signal intensity within the dilated small intestine (arrow), in contrast to adjacent normal bowel (“black-and-white sign”). (B) The twisted bowel loop (arrowhead) appears oval-shaped with wall thickening—resembling a “coffee-bean sign.”  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.  \nClinical Case Reports, 2026; 14:e71787 1 of 2  \n[https://doi.org/10.1002/ccr3.71787](https://doi.org/10.1002/ccr3.71787)  \nFIGURE 2 | Postnatal laparotomy shows twisted and discolored small intestine with segmental perforation.  \nneonate underwent laparotomy 3 h after delivery. Laparotomy confirmed twisted necrotic small intestine (Figure 2). Segmental resection was performed, and the postoperative course was uneventful. The infant was discharged on postoperative day 50 and remained healthy at 3-year follow-up.  \n2 | Answer  \n2.1 | Diagnosis: Fetal Small Intestinal Volvulus  \nIntrauterine diagnosis of fetal small intestinal volvulus is increasing due to improved diagnostic techniques, although it remains rare [1] . Ultrasound is the main diagnostic tool, but not many cases show specific findings such as the whirlpool sign, and distinguishing it from gastrointestinal atresia can be difficult. However, when small bowel torsion occurs in utero, prognosis may be poor and forced delivery may be required, so accurate diagnosis is important. In recent years, MRI has been used for diagnosis of various fetal diseases, and as imaging time has shortened, diagnostic accuracy has improved. There are still few reports on fetal small intestinal volvulus diagnosed by MRI, but in addition to the whirlpool and coffee-bean signs seen on ultrasound, the black-and-white sign reflecting ischemic changes has been described [2] . Fetal MRI should not be performed routinely in all cases with ascites, but it can be valuable when ultrasound findings are inconclusive or ischemic bowel change is suspected. Differential diagnoses include intestinal atresia, meconium peritonitis, and midgut malrotation. In volvulus, MRI typically shows the coffee-bean sign and low T2 signal (“black-and-white sign”) indicating ischemia, which are not observed in simple atresia.  \nAuthor Contributions  \nMiyu Nakamura: data curation, investigation, writing – original d","cbCaivddeUEIMEue","https://ap.wps.com/l/cbCaivddeUEIMEue","pdf",353572,"English","# Case Description\n## Diagnosis: Fetal Small Intestinal Volvulus\n# Answer\n# Author Contributions\n# Acknowledgments\n# Consent\n# Conflicts of Interest\n# Data Availability Statement\n# References","[{\"question\":\"Why was fetal MRI performed in this case?\",\"answer\":\"Ultrasound showed fetal ascites and dilated intestines, but the cause was unclear. MRI was used to differentiate volvulus from other possibilities such as intestinal atresia, meconium peritonitis, and bowel obstruction.\"},{\"question\":\"What MRI signs supported the diagnosis of small intestinal volvulus?\",\"answer\":\"Fetal MRI showed a low T2 signal in dilated intestines (“black-and-white sign”) and adjacent thickened oval loops suggesting torsion (“coffee-bean sign”).\"},{\"question\":\"How did the prenatal diagnosis affect management and outcome?\",\"answer\":\"Emergency cesarean delivery was performed at 33 weeks, followed by laparotomy 3 hours after birth. Segmental resection confirmed twisted necrotic intestine, with an uneventful postoperative course and health maintained at 3-year follow-up.\"}]","Prenatal MRI Detection of Fetal Small Intestinal Volvulus - The Black-and-White and Coffee-Bean Signs | PDF",1790573092]