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2003-05-20-11 Answer to case of the week #96 © Gourand www.TheFetus.net


Answer to case of the week # 96

May 30 - June 12

Luc Gourand, MD

Service de médecine foetale, Institut de Puériculture et Périnatalogie, Paris, France

The following images were obtained in a 3rd trmester fetus.

The images demonstrated a large pelvic mass with scattered echogenic material inside. In real time this echogenic material was seen to swirl around. The Doppler image demonstrate that the bladder was eutopic but adjacent to the bowel lesion.

 

Unfortunately this is one of those “Aunt Minnie” case (for those not familiar with the jargon this is a mispronunciation of “ain’t many”  which means that is a rare case and you just have to know the appearance of it…

 

This is the result of a vesico-enteric fistula (rectourinary in this case). Several such cases have been reported and as many midline defects they are more common in twins.

 

The fetus was delivered at 34 weeks. The co-twin was unremarkable. The affected fetus had an imperforated anus, a left undescended testicle and signs of intestinal obstruction and to prevent a rupture a temporary colostomy was performed. The surgeons did not find a fistula. However, 6 month later the newborn was reoperated for repeated urinary infection and the fistula located.

 

These are a few references of similar cases:

 

Mandell J, Lillehei CW, Greene M, Benacerraf BR. The prenatal diagnosis of imperforate anus with rectourinary fistula: dilated fetal colon with enterolithiasis.

J Pediatr Surg. 1992 Jan;27(1):82-4.

 

The finding of extraluminal calcifications is commonly reported and usually indicates intrauterine intestinal perforation with intraperitoneal extravasation of meconium, most often associated with intestinal obstruction and/or atresias. Intraluminal calcification of meconium is more rare and appears to result from the mixing of stagnant urine and meconium in utero. The presence of the intraluminal calcifications in a dilated loop of intestine, particularly with an associated urinary tract abnormality, should suggest a rectourinary fistula. Two cases of prenatally diagnosed imperforate anus with rectourinary fistulae are reported.

 

 

1: Duncan AW.: Quiz case. Multiple calcifications of intraluminal meconium enterolithiasis. Eur J Radiol. 2001 Feb;37(2):120-2.

 

2: Achiron R, Frydman M, Lipitz S, Zalel Y.: Urorectal septum malformation sequence: prenatal sonographic diagnosis in two sets of discordant twins. Ultrasound Obstet Gynecol. 2000 Nov;16(6):571-4.

 

3: Herman TE.: Special imaging casebook. High imperforate anus with enterolithiasis and dysraphism with large meningomyelocele. J Perinatol. 2000 Jan-Feb;20(1):66-7.

 

4: Anderson S, Savader B, Barnes J, Savader S. Enterolithiasis with imperforate anus. Report of two cases with sonographic demonstration and occurrence in a female. Pediatr Radiol. 1988;18(2):130-3.

 

5: Pouillaude JM, Meyer P, Tran Minh V, Dodat H, Valla JS.: Enterolithiasis in two neonates with oesophageal and anorectal atresia. Pediatr Radiol. 1987;17(5):419-21.

 

6: Giacoia GP, Winchester P, Brill PW.: Imaging case of the month. Neonatal enterolithiasis. Am J Perinatol. 1986 Apr;3(2):157-8.

 

7: Dodat H, Galifer B, Grisard M, Robert M, Sauvage P.: [Neonatal enterolithiasis (or intraluminal meconial calcifications). Apropos of  4 cases]. Chir Pediatr. 1983;24(3):183-5.

 

8: Berdon WE, Baker DH, Wigger HJ, Mitsudo SM, Williams H, Kaufmann HJ, Shapiro

L. Calcified intraluminal meconium in newborn males with imperforate anus. Enterolithiasis in the newborn. Am J Roentgenol Radium Ther Nucl Med. 1975 Oct;125(2):449-55.

 

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