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  2016-08-06  Case of the week # 433  © Lilit Hovsepyan
Answer to the case of the week # 433
November 10, 2016 - November 24, 2016.

Lilit Hovsepyan
, MD.
Erebouni Medical Center, Armenia.

Case report

A 28-year old woman with non-contributive history (G1P0) was sent to our unit to routine examination at 19 weeks of gestational age. Our ultrasound examination revealed dilated bowel loops and enterolithiasis  as a result of the intraluminal mixture of the meconium and alkaline fetal urine. These findings suggests the presence of a fistula between enteric and urinary system.
The urinary bladder was enlarged and external genitalia could not be clearly determined.

Diagnosis of complete urorectal septum malformation (URSM) sequence was made and the parents opted for termination of the pregnancy.

The diagnosis was confirmed postnatally. 

Images 1-4, videos 1-4: 2D images of the fetal abdomen and pelvis show dilated bowel loops, dilated bladder and enterolithiasis. The presence of urorectal fistula and therefore the presence of urine in the fetal bowel plays a critical role in the process of meconium calcification.


Images 5-8: pathology images revealed ambiguous genitalia and imperforate anus. 
Autopsy examination revealed distention of the urinary bladder with outlet obstruction, a fistula between the dilated distal small intestine and the rectal atresia. The colon ended in a dilated meconium-filled blind pouch.

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