Sonographic investigations of the gastrointestinal tract of granivorous birds

This article describes the sonographic examination of the normal gastrointestinal tract of granivorous birds. Preliminary tests with dead birds were performed to get an idea of the sonographic echotexture of the avian gastrointestinal tract. Later, clinically healthy seedeaters of different weights were examined sonographically. As equipment a convex microcurved scanner with a particularly small coupling surface and an adjustable frequency from 5.5-7.5 MHz was used. For the investigation of the gastrointestinal tract, six sonographic approaches are described. After a starving time of 18 hours in the granivorous birds and water input, the best sonographic image quality could be obtained. Using this method, the crop, ventriculus, intestines, and cloaca could be demonstrated sonographically; whereas, it was not possible to visualize the normal proventriculus in granivorous birds. In contrast to mammals, the different layers of the wall of the gastrointestinal tract could not be visualized with the equipment used. Motility of individual parts of the gastrointestinal tract (GI tract), however, could be well demonstrated.

Non-visualisations of the fetal bladder: aetiology and management

Failure to detect a normally filled fetal bladder on ultrasound scanning can imply the presence of a serious urogenital abnormality. Detailed scanning may elicit the underlying pathology, but there may be complex anomalies present, the full extent of which often has to await the results of postnatal investigations. Management in a combined paediatric urology:fetal medicine clinic is recommended.

Spinal ultrasound in cloacal exstrophy

AIM

To assess the diagnostic value of spinal ultrasound in cloacal exstrophy, a caudal malformation which is associated with spinal dysraphism, and to assess the prevalence of spinal dysraphism in cloacal exstrophy.

MATERIALS AND METHODS

Ten infants under 1 year old with cloacal exstrophy underwent spinal ultrasound at presentation. Three patients also had a magnetic resonance imaging (MRI) examination. Ultrasound and MRI images were reviewed and correlated.

RESULTS

Nine of 10 patients had no external signs of spinal dysraphism. One patient had a clinically apparent myelomeningocele. Five of 10 patients (50%) had spinal dysraphism on ultrasound: there were two patients with a low cord, two with tethered cords and a lipoma, and one patient with tethering and a myelomeningocele. Thus, in four of these five patients spinal dysraphism was occult. In a small number of patients (n = 3) MRI was also performed-in these cases the MRI and ultrasound appearances correlated, however MRI was not performed in those patients in whom spinal ultrasound was normal.

CONCLUSION

In three cases where spinal ultrasound detected occult dysraphism and MRI was performed, spinal ultrasound and MRI correlated. Advantages of spinal ultrasound include ease of examination, production of high quality multi-planar images and the facility for portable imaging at the bedside. Spinal ultrasound should be the first investigation in all babies with cloacal exstrophy to diagnose occult and non-occult spinal dysraphism.

Prenatal diagnosis of cloacal exstrophy before rupture of the cloacal membrane

We describe a case of cloacal exstrophy what was diagnosed prenatally by ultrasound and confirmed at birth. We also review the literature on 15 previous prenatally diagnosed cloacal extrophy cases.

Persistent cloaca: are we ready for a correct prenatal diagnosis?

Cloacal malformations are rare and can present in variable aspects. The importance of ultrasound in detecting these anomalies is well known. Sonographic features vary in accordance with the type of malformation and the gestational age. A positive diagnosis is not possible because of the lack of specific ultrasound findings, which can show similar aspects to other abnormalities. We present 3 cases of prenatal diagnosis of this malformation, emphasizing that in the presence of a plurilobed cystic pelvic fetal mass with associated malformations, such as cardiac, renal, and vertebral anomalies, a persistent cloaca can reasonably be suspected.

[Cloacal exstrophy, ultrasonic diagnosis]

This study aims to underline the importance of transvaginal ultrasonography in the first three months of pregnancy. The authors report a case which was referred to their attention for preliminary tests performed prior to amniocentesis, recommended by the general physician because of the mother's age. The primapara woman and father of the fetus were healthy and the family history excluded hereditary diseases or congenital pathologies. Transvaginal ultrasonography permitted the diagnosis at the start of the fourth month of pregnancy of a polymalformed fetus with cloacal exstrophy, sacral myelomeningocele, clubfoot, single umbilical artery. In this case, the mother decided to undergo eugenic abortion in view of the severity of the pathology.

[Diagnostic prenatal ultrasonography of malformations of the fetal anterior abdominal wall]

Abdominal wall defects include a broad spectrum of structural malformations with variable severity and prognosis. The purpose of prenatal ultrasound examination is to correctly diagnose and classify these malformations according to their localization (particularly their relation to the umbilical cord insertion), their contents, their size and associated malformations or karyotypic abnormalities. Based on this examination, two groups can be distinguished: gastroschisis or omphalocele (when the latter is isolated, in particular without karyotypic abnormalities) which can be surgically corrected at birth, and for which predictive criteria of outcome must be evaluated (vitality of herniated bowel, size and contents of omphalocele); severe malformations (ectopia cordis, cloacal exstrophy, Beckwith-Wiedemann syndrome, short umbilical cord, amniotic band syndrome) for which pregnancy termination could be proposed.

The prenatal diagnosis of cloacal exstrophy

PURPOSE

We assess and clarify diagnostic features for making the prenatal diagnosis of cloacal exstrophy.

MATERIALS AND METHODS

We evaluated 9 patients born with cloacal exstrophy at our institutions (2 prospectively and 7 retrospectively) for diagnostic features on prenatal ultrasound studies. We also thoroughly reviewed the literature on 13 previous prenatally diagnosed cloacal exstrophy cases. Diagnostic criteria were assessed by combining the findings in our patients and those in previous reports.

RESULTS

Of the 22 patients with prenatal ultrasound studies and cloacal exstrophy whom we analyzed 1 of our 9 and 2 in the literature had a cloacal membrane that persisted at 22 weeks of gestation. Major ultrasound criteria for diagnosing cloacal exstrophy prenatally are nonvisualization of the bladder, a large midline infraumbilical anterior wall defect or cystic anterior wall structure (persistent cloacal membrane), omphalocele and lumbosacral anomalies. Seven less frequent or minor criteria include lower extremity defects, renal anomalies, ascites, widened pubic arches, a narrow thorax, hydrocephalus and 1 umbilical artery.

CONCLUSIONS

We propose major and minor criteria to assist in the prenatal diagnosis of cloacal exstrophy. Despite these major and minor criteria the certainty of establishing a prenatal diagnosis remains challenging. Persistence of the cloacal membrane beyond the first trimester in 1 patient was an exception to the classic concept of cloacal exstrophy embryogenesis. An accurate prenatal diagnosis requires validation of these criteria by further correlation of prenatal and postnatal observations.

Prenatal diagnosis of cloacal anomaly

The authors present a case of prenatal diagnosis of cloacal anomaly, characterized by the presence of oligohydramnios and cystic pelvic mass with changing features during observation. Postnatal study confirmed the presence of a recto-cloacal fistula, with a high confluence of the urinary, genital and intestinal systems. Both parents had a chromosome 9 inversion (p11q13), but the child was chromosomally normal.

First-trimester prenatal sonographic findings associated with OEIS (omphalocele-exstrophy-imperforate anus-spinal defects) complex: a case and review of the literature

First-trimester sonographic findings associated with omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex and review of the literature regarding this rare congenital anomaly are presented.

Late prenatal ultrasound features of hydrometrocolpos secondary to cloacal anomaly: case reports and review of the literature

Cloacal anomalies are extremely rare and have variable presentations. Prenatal diagnosis can be difficult especially if they present in late gestation. Here we present two cases diagnosed in the late third trimester and review the literature regarding prenatal diagnosis of cloacal anomalies.

Prenatal diagnosis of fetal bladder and cloacal exstrophy by ultrasound. A report of three cases

BACKGROUND

Bladder and cloacal exstrophy can be diagnosed with prenatal ultrasound.

CASES

Three cases of bladder and cloacal exstrophy were diagnosed prenatally by ultrasound and confirmed at birth. The ultrasound findings were a soft tissue mass in the lower abdominal wall (which appeared larger and more heterogeneous in cloacal exstrophy than in bladder exstrophy), absent bladder, malformation of the external genitalia and normal kidneys along with normal amniotic fluid volume.

CONCLUSION

Prenatal diagnosis of these defects will allow appropriate referrals prior to birth.

Effect of salt and water balance on colonic motility of white leghorn roosters

The motility of the lower gastrointestinal (GI) tract of white leghorn roosters was observed by radiographic methods. Intracolonic pressure changes were recorded, and the mechanical activity of the colon was quantified using strain gauges that were attached to the serosa. Two types of retrograde contraction waves were observed: small fast peristaltic contractions (15 min-1) and large slow contractions. The small fast contractions are the actual vehicle of the retrograde movement, but they seemed to be linked to respiratory movements in the fashion of coupled oscillators during most of their activity time (94%). This makes them an unlikely target for regulation. The large slow waves (3 min-1) probably reflect contractions of the longitudinal musculature. They are retrograde and may permit or modulate the refluxing of urine. The effects of water deprivation, intravenous volume, and salt loads on colonic motility were analyzed. All manipulations that increased urine flow rates without changing urine osmolality resulted in increased propagation speed of the large contraction waves. All manipulations that increased urine osmolality resulted in decreases in activity time of the large-wave pattern. These results suggest a hydration state-related control of the retrograde colonic motility in birds. Direct stimulation of central osmoreceptors had no such effects, indicating that local volume and osmolality receptors of the cloaca are more important than central receptors for this adjustment of colonic motility.

Prenatal diagnosis of cloacal malformation

Cloacal malformation is a rare abnormality, occurring only in females and characterized by a direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report 2 cases of prenatal diagnosis of this condition with a varied ultrasonic appearance including fetal ascites, cystic retrovesical mass, ambiguous genitalia, nonvisualization of the bladder, and oligohydramnios.

Emergency separation of conjoined twins

Female omphalopagus conjoined twins were successfully delivered vaginally and required emergency surgical separation shortly after birth for gastroschisis. Shared tissue included conjoined bowel; one twin also had a complex cloacal abnormality and patent urachus. A 2-year follow-up is presented. A review of the relevant literature confirms that this is the first example of gastroschisis conjoining omphalopagus twins.

Obstructed uterovaginal anomalies: demonstration with sonography. Part I. Neonates and infants

The sonograms of five neonates with an obstructed urogenital sinus and four with an obstructed cloaca were retrospectively reviewed to determine the sonographic features and the role of pre- and postnatal sonography in the diagnosis and management of hydrocolpos. On pre- and/or postnatal sonograms, the obstructed genital tract was visualized in seven neonates as a large cystic pelvic-abdominal mass, which was the markedly distended urine-filled vagina. One neonate had multiple cystic masses, which resulted from an obstructed duplex genital tract. In one of the neonates with an obstructed cloaca, the anomaly was not diagnosed. The bladder was compressed by the distended vagina and was not visualized in five patients. A vaginal fluid-debris level in six patients was a key finding that distinguished the vagina from the bladder. Obstruction of the urinary tract was an associated feature. An obstructed uterovaginal anomaly with renal dysplasia and oligohydramnios on prenatal sonograms indicates a poor prognosis. Sonography contributes to the diagnosis of an obstructed genital tract and helps define the internal genital anatomy.

The cloacal malformation: radiologic findings and imaging recommendations

The imaging studies and records of 65 patients with the cloacal malformation seen from 1969 to 1989 were reviewed. The malformations were described according to cloacal configuration (urethral, vaginal), type of urinary-cloacal communication (urethral, vesical), and level of rectal communication (vaginal, cloacal, vesical, other). Lower urinary tract abnormalities were frequent (reflux, ureteral ectopia, bladder diverticula, bladder duplication, urachal remnants, urethral duplication), as were genital abnormalities (uterine duplication, vaginal duplication, uterine atresia, vaginal atresia), abnormalities of the bony pelvis (partial sacral agenesis, pubic diastasis), and renal abnormalities (agenesis, obstruction, horseshoe kidney). Contrast material studies of the cloaca and the distal limb of the colostomy with fluoroscopy in various projections were essential for diagnosis. Voiding cystourethrography was important for detecting vesicoureteric reflux. Sonography was of limited value for evaluation of the malformation but was valuable for imaging the kidneys. MR imaging revealed that spinal cord abnormalities cannot be predicted based on the appearance of the lumbosacral spine and are more common than previously thought.

Association of congenital vertebral malformations with bladder and cloacal exstrophy

The radiographs of 28 patients with bladder exstrophy and five with cloacal exstrophy were reviewed at an average age of 8 years 3 months to assess congenital vertebral malformations. Fourteen malformations in 11 patients were noted, including abnormal lumbosacral segmentation in five, congenital scoliosis and kyphosis in four, partial sacral agenesis in three, and interpedicular lumbar widenings in two. These findings are explained by an abnormal embryologic development of the spine and cloaca between 4 and 6 weeks of intrauterine life. We recommend entire spinal radiographs in these patients.