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Fetal and Newborn Management of Cloacal Malformations. CHILDREN 2022; 9:children9060888. [PMID: 35740825 PMCID: PMC9221828 DOI: 10.3390/children9060888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Perinatal evaluation and management may include treatment of cardiopulmonary and renal anomalies, administration of prophylactic antibiotics, ensuring egress of urine and evaluation of hydronephrosis, drainage of a hydrocolpos, and creation of a colostomy for stool diversion. Additional imaging of the spinal cord and sacrum are obtained to plan possible neurosurgical intervention as well as prognostication of future bladder and bowel control. Endoscopic evaluation and cloacagram, followed by primary reconstruction, are performed by a multidisciplinary team outside of the neonatal period. Long-term multidisciplinary follow-up is essential given the increased rates of renal disease, neuropathic bladder, tethered cord syndrome, and stooling issues. Patients and families will also require support through the functional and psychosocial changes in puberty, adolescence, and young adulthood.
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Kim HM, Cha HH, Kim JI, Seong WJ, Park SH, Kim MJ. The diagnosis of an imperforate anus in female fetuses. Yeungnam Univ J Med 2020; 38:240-244. [PMID: 33022903 PMCID: PMC8225495 DOI: 10.12701/yujm.2020.00507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 11/04/2022] Open
Abstract
Imperforate anus is an anomaly caused by a defect in the development of the hindgut during early pregnancy. It is a relatively common congenital malformation and is more common in males. Although there are cases of a solitary imperforate anus, the condition is more commonly found as a part of a wider spectrum of other congenital anomalies. Although urgent reconstructive anorectal surgery is not necessary, immediate evaluation is important and urgent decompressive surgery may be required. Moreover, as there are often other anomalies that can affect management, prenatal diagnosis can help in optimizing perinatal care and prepare parents through prenatal counseling. In the past, imperforate anus was diagnosed by prenatal ultrasonography based on indirect signs such as bowel dilatation or intraluminal calcified meconium. Currently, it is diagnosed by directly checking the perineum with prenatal ultrasonography. Despite advances in ultrasound technology, accurate prenatal diagnosis is impossible in most cases and imperforate anus is detected after birth. Here, we present two cases of imperforate anus in female fetuses that were not diagnosed prenatally.
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Affiliation(s)
- Hyun Mi Kim
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong In Kim
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sook-Hyun Park
- Department of Pediatrics, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mi Ju Kim
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
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3
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Goncalves LF, Hill H, Bailey S. Prenatal and postnatal imaging techniques in the evaluation of disorders of sex development. Semin Pediatr Surg 2019; 28:150839. [PMID: 31668296 DOI: 10.1016/j.sempedsurg.2019.150839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Imaging of the reproductive tract is challenging and requires a general knowledge of congenital variations in anatomy. The anatomy of the developing fetus, whether a male phenotype or female phenotype, is also a dynamic process with many changes occurring during gestation. Families may ask details about the genitalia during prenatal imaging and when variations in what is thought to be normal are present, further investigation is sometimes needed to make sense of what is seen. This overview will describe categories of disorders of sex development (DSD), whether chromosomal or structural or both, and the current state of imaging of these anomalies.
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Affiliation(s)
- Luis F Goncalves
- Director of Fetal Imaging, Division of Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States.
| | - Halsey Hill
- St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Smita Bailey
- Division of Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States
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Mallmann MR, Reutter H, Gottschalk I, Geipel A, Berg C, Gembruch U. Prenatal Diagnosis of Enterolithiasis in 20 Cases. Fetal Diagn Ther 2019; 46:266-273. [PMID: 30879001 DOI: 10.1159/000496843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enterolithiasis is a sonographic sign defined by hyperechogenic foci within the - often distended - fetal bowel. OBJECTIVES We report on a series of 20 cases with enterolithiasis diagnosed prenatally and illustrate the spectrum of associated malformations. METHOD This was a retrospective study involving 20 fetuses with enterolithiasis at two large tertiary referral centers in Germany over a 17-year period (2000-2017). RESULTS Median diagnosis was made with ultrasound at 18+2 weeks of gestation (IQR25,75: 14+5, 26+5). Additional malformations included urogenital malformations (cloacal malformation in 7/20 fetuses [35%] and kidney defects in 7/20 fetuses [35%]), cardiac malformations (3/20 fetuses [15%]), and vertebral malformations (5/20 fetuses [25%]). Of 20 fetuses, 14 could be attributed to the anorectal malformation spectrum, 3/20 fetuses presented with caudal regression syndrome, and 1 fetus with bilateral kidney agenesis, congenital diaphragmatic aplasia, and enterovesical fistula, respectively. CONCLUSION Enterolithiasis is a rare prenatal sonographic feature. Because of the frequent occurrence of uro-recto-genital malformations, thorough prenatal counseling should be performed.
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Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.,Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.,Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany,
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5
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Second trimester diagnosis of imperforate anus. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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6
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Perlman S, Bilik R, Leibovitch L, Katorza E, Achiron R, Gilboa Y. More than a gut feeling - sonographic prenatal diagnosis of imperforate anus in a high-risk population. Prenat Diagn 2014; 34:1307-11. [DOI: 10.1002/pd.4472] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/19/2014] [Accepted: 07/24/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Sharon Perlman
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology; The Haim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Ron Bilik
- Department of Pediatric Surgery; The Haim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Leah Leibovitch
- Department of Neonatology, The Edmond and Lily Safra Children's Hospital; The Haim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Eldad Katorza
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology; The Haim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Reuven Achiron
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology; The Haim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Yinon Gilboa
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology; The Haim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
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Shiozaki A, Yoneda S, Iizuka T, Kusabiraki T, Ito M, Ito M, Yoneda N, Yoshimoto H, Saito S. Prenatal diagnosis of enterolithiasis at 18 weeks: multiple foci of intraluminal calcified meconium within echogenic bowel. J Med Ultrason (2001) 2014; 42:113-6. [PMID: 26578499 DOI: 10.1007/s10396-014-0561-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
Abstract
Enterolithiasis is an uncommon finding of a dilated hyperechogenic bowel with multiple ball-like echogenic structures at a routine prenatal check-up using ultrasonography. We here report a case of prenatally diagnosed enterolithiasis at 18 weeks of gestation, showing multiple hyperechogenic foci rolling within the bowel fluid after peristalsis. The size of the dilated bowel gradually increased during pregnancy. Magnetic resonance image demonstrated the dilated lower bowel with blind-ending rectum. A postnatal contrast medium study with retrograde urethrography revealed a middle imperforate anus and a rectourethral fistula. A careful examination, even before 20 weeks of gestation, is extremely useful in demonstrating intraluminal coarse calcifications within an echogenic bowel.
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Affiliation(s)
- Arihiro Shiozaki
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Satoshi Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takashi Iizuka
- Department of Obstetrics and Gynecology, Saiseikai Takaoka Hospital, 387-1 Futazuka, Takaoka, 933-8525, Japan
| | - Tae Kusabiraki
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Masami Ito
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Mika Ito
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hideo Yoshimoto
- Department of Obstetrics and Gynecology, Saiseikai Takaoka Hospital, 387-1 Futazuka, Takaoka, 933-8525, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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8
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Ochoa JH, Chiesa M, Vildoza RP, Wong AE, Sepulveda W. Evaluation of the perianal muscular complex in the prenatal diagnosis of anorectal atresia in a high-risk population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:521-527. [PMID: 21728206 DOI: 10.1002/uog.9083] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To investigate whether sonographic identification of the fetal perianal muscular complex (PAMC) is of value in the prenatal detection of anorectal atresia in a high-risk population. METHODS During an 8-year study period, a total of 189 pregnancies at high risk for fetal anorectal atresia were prospectively examined for the presence/absence of the PAMC on axial ultrasound views of the fetal perineum. The prenatal findings were confirmed postnatally or at the time of postmortem examination. RESULTS The median gestational age at examination was 27 (range, 15-37) weeks. The PAMC was identified in 175 fetuses, all of which had a normal anorectal canal at the time of delivery or at postmortem examination. The PAMC was not identified prenatally in the 14 remaining cases, and the anus was absent in 11 fetuses with anorectal atresia and in two with urorectal septum malformation sequence. There was one false-positive case, in which the anus was anatomically and functionally normal but ectopically located, opening into the vaginal vestibule. Among these 14 cases of anorectal malformation, prenatal dilatation of the distal bowel was seen in nine (64.3%) and intraluminal calcified meconium or enterolithiasis in five (35.7%). Overall, absent PAMC on prenatal sonography in this high-risk population had a sensitivity of 100%, specificity of 99%, true-positive rate of 93% and false-positive rate of 7% for the diagnosis of anorectal atresia. CONCLUSIONS In a high-risk population, the absence of PAMC seems to be a highly sensitive and specific sonographic marker for anorectal atresia. The role of routine sonographic identification of the PAMC at the second-trimester scan to screen for cases of isolated anal atresia remains to be determined.
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Affiliation(s)
- J H Ochoa
- Diagnus, Prenatal Diagnosis and Teaching Center, Córdoba, Argentina.
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9
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Calvo-Garcia MA, Kline-Fath BM, Levitt MA, Lim FY, Linam LE, Patel MN, Kraus S, Crombleholme TM, Peña A. Fetal MRI clues to diagnose cloacal malformations. Pediatr Radiol 2011; 41:1117-28. [PMID: 21409544 DOI: 10.1007/s00247-011-2020-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 12/29/2010] [Accepted: 02/07/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis. OBJECTIVE To define the prenatal MRI findings in cloacal malformations. MATERIALS AND METHODS We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution. Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was focused on the distal bowel, the urinary system and the genital tract and compared with postnatal clinical, radiological and surgical diagnoses. RESULTS The distal bowel was dilated and did not extend below the bladder in five fetuses. They had a long common cloacal channel (3.5-6 cm) and a rectum located over the bladder base. Only one fetus with a posterior cloacal variant had a normal rectum. Three fetuses had increased T2 signal in the bowel and two increased T1/decreased T2 signal bladder content. All had renal anomalies, four had abnormal bladders and two had hydrocolpos. CONCLUSION Assessment of the anorectal signal and pelvic anatomy during the third trimester helps to detect cloacal malformations in the fetus. The specificity for this diagnosis was highly increased when bowel fluid or bladder meconium content was identified.
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Affiliation(s)
- Maria A Calvo-Garcia
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
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Diagnostic anténatal et prise en charge des extrophies vésicales isolées. ACTA ACUST UNITED AC 2010; 38:624-30. [DOI: 10.1016/j.gyobfe.2010.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/28/2010] [Indexed: 11/22/2022]
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11
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Puvabanditsin S, Garrow E, Chinnakaruppan N, Bhatt M, Brandsma E. Calcified meconium balls in a newborn: an unusual case with imperforate anus, rectourinary fistula, colpocephaly, and agenesis of corpus callosum. Pediatr Surg Int 2009; 25:441-3. [PMID: 19319541 DOI: 10.1007/s00383-009-2355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2009] [Indexed: 11/29/2022]
Abstract
Calcified intraluminal meconium is a rare finding in newborn infants. It is often associated with communication between the urinary and gastrointestinal tracts. Intra-abdominal calcifications are unusual radiographic findings in the newborn and can easily be misinterpreted as meconium peritonitis. We report on a newborn infant with anorectal malformation, meconium balls, intraluminal calcifications, colpocephaly, and agenesis of the corpus callosum, a rare association.
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Affiliation(s)
- Surasak Puvabanditsin
- Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, One Robert Wood Johnson Place, New Brunswick, NJ 08903, USA.
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12
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Enterolithiasis: a case report and review. J Pediatr Surg 2009; 44:828-30. [PMID: 19361648 DOI: 10.1016/j.jpedsurg.2008.11.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 11/07/2008] [Accepted: 11/08/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Enterolithiasis is an uncommon finding of intraluminal calcified meconium. Whereas extraluminal calcifications are commonly reported and usually indicate intrauterine intestinal perforation with intraperitoneal extravasation of meconium (meconium peritonitis), true intraluminal calcifications of meconium in newborns are rare. CASE REPORT We report a case of a newborn boy with pneumothorax and pneumoperitoneum because of a transmediastinal air leakage who unfortunately died on the fifth postnatal day after a pneumopericard. The baby had lung hypoplasia and a hypoplastic thorax. Oligohydramnion was present because of urethral agenesis and anal atresia with rectourinary fistula. Enterolithiasis was found, distributed from the transverse to the rectosigmoid colon. Enterolithiasis was not diagnosed prenatally in this boy, and any of those preexisting pathologies were therefore not assumed before birth except the suspicion for urethral valves because of oligohydramnion. DISCUSSION Approximately 48 cases of human neonatal enterolithiasis have been described in the medical literature. The etiology of enterolithiasis appears to be intraluminal mixture of meconium und alkaline urine--as it appears in anal atresia with enterourinary fistula. Most cases of enterolithiasis are associated with major urogenital and intestinal malformations--especially VACTERL association. With support of modern high-resolution imaging devices, enterolithiasis can be detected antenatally. We suppose that prenatal diagnosis of enterolithiasis is a warning sign of underlying pathologies.
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14
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Bladder outlet obstruction causes fetal enterolithiasis in anorectal malformation with rectourinary fistula. J Pediatr Surg 2008; 43:e11-3. [PMID: 18405693 DOI: 10.1016/j.jpedsurg.2007.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/13/2007] [Accepted: 11/17/2007] [Indexed: 11/20/2022]
Abstract
Extraluminal calcified meconium is found frequently by prenatal ultrasound in cases with bowel perforation and meconium peritonitis. Intraluminal intestinal meconium calcifications are rarely seen in prenatal sonography. Meconium calcifications result from a mixture of meconium and urine that indicates a connection between intestinal and urinary tract. We report a case of a male newborn prenatally diagnosed with intraluminal echogenic calcifications at 23 weeks of gestation, suggesting an anorectal malformation (ARM) with rectourinary fistula. At birth, the child presented with a complex ARM including high anal atresia with both perineal and rectourethral fistula. Furthermore, a bladder outlet obstruction due to a urethral stenosis was diagnosed. Vesicostomy was performed as an emergency procedure followed by colostomy during neonatal period. Posterior sagittal anorectoplasty was performed at the age of 4 months. Prenatal echogenic calcifications within bowel should raise the suspicion of ARM with rectourinary fistula and bladder outlet obstruction.
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Bang WJ, Lee HY, Han SW. Clinical Characteristics of Children with Persistent Cloaca: A Urological Perspective. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.1.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Woo Jin Bang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Fetal megalourethra associated with hypoplastic left heart and imperforate anus: a previously unreported association. Clin Dysmorphol 2007; 17:47-51. [PMID: 18049081 DOI: 10.1097/mcd.0b013e32827424f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report two cases of a fetus with a megalourethra associated with a hypoplastic left heart, dilated and echogenic bowels, vesico-colonic fistula and an imperforate anus. This combination of fetal abnormalities may represent an unclassified syndrome.
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17
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Gorincour G, Grignon A, Oligny L. A dire finding. Am J Obstet Gynecol 2007; 196:493.e1-2. [PMID: 17466718 DOI: 10.1016/j.ajog.2007.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 10/24/2006] [Accepted: 03/14/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Guillaume Gorincour
- Department of Pediatric Radiology, Sainte Justine Hospital, Montreal, Quebec, Canada
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18
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Brantberg A, Blaas HGK, Haugen SE, Isaksen CV, Eik-Nes SH. Imperforate anus: A relatively common anomaly rarely diagnosed prenatally. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:904-10. [PMID: 17091530 DOI: 10.1002/uog.3862] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Despite the relatively common occurrence of imperforate anus, prenatal diagnosis is rarely reported. In this study, we investigated the presence and diagnosis of imperforate anus along with strategies for improving prenatal diagnosis of the condition. PATIENTS AND METHODS Fetuses and infants with imperforate anus who had been examined prenatally by ultrasound at the National Center for Fetal Medicine (NCFM) from 1987 to 2004, were evaluated. RESULTS Of 69 cases with imperforate anus, only 11 (15.9%) were diagnosed prenatally, at a median gestation of 18 + 4 (range, 15 + 6 to 35 + 6) weeks. In all 11, dilatations of the rectum or lower part of the bowel were seen. Additional anomalies, most of them diagnosed prenatally, were present in 59/69 (85.5%) of the cases. The most frequent additional anomalies were urogenital (53.6%). The karyotype was abnormal in nine cases (13.0%). A retrospective evaluation of available videotapes of 22 cases of imperforate anus that were not diagnosed prenatally revealed that it was possible to suspect the diagnosis in 11/22 (50%) cases. Sixteen infants were born with imperforate anus without prenatal diagnosis of any abnormality. In total, 31/69 (44.9%) cases were terminated, two (2.9%) died in utero and 12 (17.4%) died postnatally. Twenty-four (34.8%) infants survived, including all 10 with isolated imperforate anus and seven of eight cases with only one additional anomaly. CONCLUSIONS The prenatal detection rate of imperforate anus was only 15.9%. Imperforate anus is often associated with other anomalies; in this study, 85.5% had additional anomalies. Prenatal diagnosis makes prenatal counseling possible and facilitates optimized postnatal care. We believe that the prenatal detection rate of imperforate anus could be improved. Examiners should intensify their search for typical findings of imperforate anus especially when other anomalies that frequently accompany this condition are present.
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Affiliation(s)
- A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Norwegian University of Science and Technology, Trondheim, Norway.
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Dulay AT, Schwartz N, Laser A, Greco MA, Monteagudo A, Timor-Tritsch IE. Two- and 3-dimensional sonographic diagnosis of a vesicorectal fistula in cloacal dysgenesis sequence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1489-94. [PMID: 17060441 DOI: 10.7863/jum.2006.25.11.1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Antonette T Dulay
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University School of Medicine, New York, NY 10016 USA
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Pohl-Schickinger A, Henrich W, Degenhardt P, Bassir C, Hüseman D. Echogenic foci in the dilated fetal colon may be associated with the presence of a rectourinary fistula. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:341-4. [PMID: 16888707 DOI: 10.1002/uog.2852] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Intraintestinal meconium calcification in the fetus and newborn is a rare finding, occurring in patients with intestinal obstruction. The intraluminal location of the enterolithiasis enables differentiation from calcifications that are secondary to bowel perforation and meconium peritonitis. We report on a term male neonate with VACTERL (vertebral defects, imperforate anus, cardiac anomalies, tracheoesophageal fistula, renal anomalies, limb anomalies) association and rectourethral fistula, in whom enterolithiasis was documented by prenatal ultrasound imaging at 21 weeks' gestation. A review of the literature and a summary of all previously described cases of neonates with intraluminal meconium calcifications are provided. Prenatal ultrasonographic detection of enterolithiasis in fetuses with anal atresia may indicate the presence of an enterourinary fistula.
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Affiliation(s)
- A Pohl-Schickinger
- Department of Neonatology, Campus Virchow Klinikum, University Hospital Charité, Berlin, Germany.
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21
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Lubusky M, Prochazka M, Dhaifalah I, Horak D, Geierova M, Santavy J. Fetal enterolithiasis: prenatal sonographic and MRI diagnosis in two cases of urorectal septum malformation (URSM) sequence. Prenat Diagn 2006; 26:345-9. [PMID: 16566038 DOI: 10.1002/pd.1415] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Enterolithiasis (multiple calcifications of intraluminal meconium) is a rare, prenatal ultrasonographic finding. In this study, our aim was to evaluate the prenatal diagnostic features and discuss the management of the patients. METHODS The data of two cases of prenatally diagnosed fetal enterolithiasis were collected from ultrasound scan, magnetic resonance imaging (MRI) and neonatal or postnatal autopsy records. The findings were evaluated in both prenatal and postnatal periods. Chromosomal analysis was performed in one case. An evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for via radiology, neonatal surgery and histopathology. RESULTS Malformations in two cases (both males) with partial and complete urorectal septum malformation (URSM) sequence were described. The absence of an anal opening and presence of a fistula between the urinary and gastrointestinal tract were common findings. These features were considered as primary malformations contributing to the formation of enterolithiasis. Secondary anomalies (urinary and gastrointestinal system malformations, pulmonary hypoplasia, genital and other coexisting anomalies) were evaluated. CONCLUSIONS The prenatal detection of enterolithiasis carries a poor prognosis. Most of the previously reported cases were invariably associated with major fetal malformations of the urinary and gastrointestinal tract. It is a warning sign for large bowel obstruction with or without enterourinary fistula. Therefore, adequate gastrointestinal and urologic studies must be undertaken after birth for the final diagnosis. There is a high mortality rate in the reported cases, mostly attributed to associated anomalies, and all survivors required neonatal surgery. It is important to differentiate the partial from the full URSM sequence because the prognosis in the partial URSM sequence is generally good, with long-term survival being common.
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Affiliation(s)
- Marek Lubusky
- Department of Obstetrics and Gynecology, University Hospital, Olomouc, Czech Republic.
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22
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Morikawa M, Yamada T, Cho K, Yamada H, Minakami H. Prenatal Diagnosis and Therapy of Persistent Cloaca: A Case Report. Fetal Diagn Ther 2006; 21:343-7. [PMID: 16757909 DOI: 10.1159/000092463] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 08/11/2005] [Indexed: 11/19/2022]
Abstract
Persistent cloaca is a rare abnormality that occurs only in females and is characterized by a direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. A case with massive ascites, two cystic structures arising from the fetal pelvis, bilateral hydroureters, calcified meconium, and cardiac anomalies, in which this condition was diagnosed prenatally is presented here.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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23
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Finnigan DF, Fisher KRS, Vrablic O, Halina WG, Partlow GD. A proposed mechanism for intermediate atresia ani (AA), based on a porcine case of AA and hypospadias. ACTA ACUST UNITED AC 2005; 73:434-9. [PMID: 15880702 DOI: 10.1002/bdra.20129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Atresia Ani (AA) is one of the most common malformations of the lower gastrointestinal tract. It occurs in 1 in 1500 to 1 in 5000 human births. These patients suffer physically and psychologically from this disorder, and thus there is a research interest in the condition. There are 3 subcategories of AA: high, intermediate, and low. Each of these forms is likely related to separate etiological processes. METHODS An anatomical study was performed on a porcine case of AA with a urorectal fistula and malformed urethra. RESULTS This animal was found to have the intermediate form of AA. CONCLUSIONS A new mechanism is hypothesized, distinct from that described for the high and low forms of AA. This proposed mechanism involves the persistence of the cloacal membrane. Evidence to support this hypothesis includes: location of the urorectal fistula in the region of the embryonic cloacal duct, the lack of anomalies usually seen in conjunction with AA associated with mutations of the Sonic Hedgehog gene, and the presence of a malformed urethra, which is significantly correlated to intermediate AA. This form of AA could be related to a failure of the cloacal membrane to break down at the appropriate time during urorectal separation.
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Affiliation(s)
- Daniel F Finnigan
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario N1G 2W1, Canada
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24
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Chaubal N, Dighe M, Shah M, Chaubal J, Raghavan J. Calcified meconium: an important sign in the prenatal sonographic diagnosis of cloacal malformation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:727-730. [PMID: 12862274 DOI: 10.7863/jum.2003.22.7.727] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cloacal malformation is a rare abnormality, characterized by direct communication between the gastrointestinal, urinary, and genital structures, resulting in a single perineal opening. Prenatal diagnosis is difficult because of nonvisualization of the communication. We report a case of prenatal diagnosis of this condition, in which the recognition of calcified meconium in the colon and urinary tract provided an important clue.
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Affiliation(s)
- Nitin Chaubal
- Thane Ultrasound Centre, Shanti Niwas, Dr Moose Road,Taloapali, Thane (W) 400 601, Maharashtra, India
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25
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Hong AR, Peña A. New developments in anal surgery: Congenital ano-rectal malformations. SEMINARS IN COLON AND RECTAL SURGERY 2003. [DOI: 10.1053/scrs.2003.000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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27
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Wong GB, Mulliken JB, Benacerraf BR. Prenatal sonographic diagnosis of major craniofacial anomalies. Plast Reconstr Surg 2001; 108:1316-33. [PMID: 11604640 DOI: 10.1097/00006534-200110000-00036] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G B Wong
- Craniofacial Centre and the Division of Plastic Surgery at Children's Hospital, Department of Radiology at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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28
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Tongsong T, Chanprapaph P. Prenatal diagnosis of isolated anorectal atresia with colonic perforation. J Obstet Gynaecol Res 2001; 27:241-4. [PMID: 11776504 DOI: 10.1111/j.1447-0756.2001.tb01263.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report here a case of prenatal diagnosis of isolated anorectal atresia with intrauterine colonic perforation at 34 weeks of gestation, characterized by the presence of a bilobed cystic pelvic mass with a V-shape appearance separated from the bladder with changing features during observation. Mild ascites was also visualized. Other structures were normal on detailed ultrasound. The patient had spontaneously delivered a male infant weighing 2,100 g at 34 weeks of gestation. The infant died one day after birth, before surgical correction secondary to respiratory distress syndrome. Autopsy revealed isolated anorectal atresia, and high (supraelevator) lesions. In conclusion, the findings of bilobed cystic pelvic mass with a V-shape were useful to diagnose anorectal atresia in this case. Prenatal ultrasound can facilitate early diagnosis and treatment.
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Affiliation(s)
- T Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
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29
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Abstract
It has been long known that the late gestation human fetus passes meconium in response to hypoxia. However, there is good evidence, from amniotic fluid studies measuring bile pigment and enteric enzyme content, to suggest that passage of meconium is a normal physiological event in the second trimester. Similarly there is some indirect evidence that fetal defaecation is a normal physiological process in the third trimester. However, this evidence is less strong, and it is safer to assume that in most cases meconium staining of liquor at this time is associated with fetal hypoxia. Dilation of the rectosigmoid portion of the distal bowel found in newborn infants with anorectal malformations supports the hypothesis that fetal colonic peristalsis and defaecation is a normal physiological process.
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Affiliation(s)
- R M Kimble
- Douglas Cohen Department of Paediatric Surgery, New Children's Hospital, Westmead, NSW, Australia.
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31
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32
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Affiliation(s)
- B S Hertzberg
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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33
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Cacciaguerra S, Lo Presti L, Di Leo L, Grasso S, Gangarossa S, Di Benedetto V, Di Benedetto A. Prenatal diagnosis of cloacal anomaly. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1998; 32:77-80. [PMID: 9561584 DOI: 10.1080/003655998750014783] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- S Cacciaguerra
- Cattedra di Chirurgia Pediatrica, Università di Catania, Italy
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34
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Abstract
We present five fetuses at 15-17 weeks' gestation with a sonographic diagnosis of intestinal obstruction. Dilation of the intestine was the presenting sonographic finding in fetuses with a volvulus and/or anal atresia. Two of the fetuses also had other abnormalities. Intestinal peristalsis may be observed in early pregnancy as transient dilation of intestinal segments. Sonographers are cautioned about a false-positive diagnosis of intestinal obstruction in such cases.
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Affiliation(s)
- M Bronshtein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Technion Faculty of Medicine, Haifa, Israel
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35
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Abstract
A review of fetal gastrointestinal anomalies is presented. Normal abdominal development and anatomy, including basic embryology and recommended ultrasound techniques, are first outlined. Next is a more detailed discussion of the abnormal examination, including abdominal wall defects and intra-abdominal abnormalities. The goal of this work is to present a practical approach to the abnormal fetal abdominal examination enabling the sonographer and sonologist to suggest precise differential diagnoses.
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Affiliation(s)
- R Sohaey
- Department of Radiology, University of Utah School of Medicine, Salt Lake City 84132, USA
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36
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37
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Mandell J, Bromley B, Peters CA, Benacerraf BR. Prenatal Sonographic Detection of Genital Malformations. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67389-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- James Mandell
- Division of Urology, Children's Hospital and Departments of Radiology, and Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryann Bromley
- Division of Urology, Children's Hospital and Departments of Radiology, and Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Craig A. Peters
- Division of Urology, Children's Hospital and Departments of Radiology, and Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Beryl R. Benacerraf
- Division of Urology, Children's Hospital and Departments of Radiology, and Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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38
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Abstract
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.
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Affiliation(s)
- B G Cilento
- Department of Surgery, Children's Hospital, Boston, Massachusetts
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