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

Research output: Contribution to journalReview articlepeer-review


Colleges, School and Institutes


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.


Original languageEnglish
JournalFetal Diagnosis and Therapy
Issue number1
Early online date14 Dec 2018
Publication statusE-pub ahead of print - 14 Dec 2018


  • Twin-to-twin transfusion syndrome, Fetoscopic laser ablation, Jejunal atresia, Ileal atresia, Necrotising enterocolitis, Bowel perforation