Calcified Intraluminal Meconium in Newborn Males With Imperforate Anus

Berdon, Walter E.; Baker, David H.; Wigger, H. Joachim; Mitsudo, Sumi; Williams, H.; Kaufmann, Herbert J.; Shapiro, Lawrence R.

doi:10.2214/ajr.125.2.449

Cited by 46 publications

(28 citation statements)

References 7 publications

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“…To the best of our knowledge, such an association has been reported only once in the literature. 1 5 From the embryologic point of view, this constellation of findings may be the result of (1) failure of the cloacal membrane to develop (agenesis), leading to the absence of genital folds, absence of a pars phallica of the urogenital sinus, absence of anal tubercles, and absence of a communication between derivates of the cloaca (bladder and rectum) and the exterior; or (2) the urorectal septum malformation sequence,1 7 in which not the absence but the persistence of the cloacal membrane results in absence of urogenital and rectal openings, the primary defect being a failure in the migration or fusion (or both) of the urorectal septum with the cloacal membrane. Most of these cases have been reported in females; 1 5-17 only a few cases have been reported in males, with the most prominent feature being the agenesis of the penis.ts, 19Jn our case, although the prenatal chromosome analysis revealed a normal male karyotype, it was not possible to demonstrate agenesis of the penis prenatally due to severe oligohydramnios.…”

Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis of enterolithiasis: a sign of fetal large bowel obstruction.

Sepúlveda

Romero

Qureshi

et al. 1994

Journal of Ultrasound in Medicine

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Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis of enterolithiasis: a sign of fetal large bowel obstruction.

Sepúlveda

Romero

Qureshi

et al. 1994

Journal of Ultrasound in Medicine

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“…Intraluminal meconium calcification has been reported in the small bowel with atresia, and it has been identified in the colon in association with anorectal atresia. 5 . 6 If discrete, highly reflective foci are noted within the fetus, they are considered to be abnormal.…”

Section: Discussionmentioning

confidence: 99%

“…Meconium stasis and enterourinary fistula with mixing of alkaline urine and meconium have been implicated. 5 However, meconium stasis is a normal finding because it is not expelled until after birth. Additionally, the theories do not explain why cal-GRANT ET AL 413 cifications were seen in our first case.…”

Section: Discussionmentioning

confidence: 99%

Intraluminal colonic calcifications associated with anorectal atresia. Prenatal sonographic detection.

Grant

Newman

Gould

et al. 1990

Journal of Ultrasound in Medicine

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Intra-abdominal meconium calcifications in the fetus can be detected with sonography.t-3 Fetal peritoneal calcifications are usually related to meconium peritonitis secondary to bowel perforation; intraluminal calcifications (enterolithiasis) are relatively rare but are often associated with bowel obstruction. 2.3 Sonographic characteristics clearly reveal the presence of calcified meconium and may distinguish intraluminal from peritoneal foci. The following is a report of two cases of prenatal detection of calcified intraluminal meconium associated with anorectal atresia. Sonographic signs useful in the antenatal diagnosis of enterolithiasis are described. To our knowledge, these have not been previously reported. CASE REPORTSCase 1 A multiparous 37-year-old woman without significant medical history presented to the obstetrics service with a 2-day history of dysuria and lower abdominal cramping. Sonography demonstrated a 30-week gestation and oligohydramnios. Fetal survey revealed a small thorax, right hydrone- phrosis, nonvisualization of the left kidney, and a dilated loop of bowel in the midabdomen. The bowel loop "mass" contained multiple coarse, highly reflective foci, 4-to 6-mm in diameter, compatible with calcifications (Fig. 1). Peristalsis in this segment was present. Four days later the patient delivered a 1,575-g girl with Apgar scores of 4 and 6. Delivery was com• plicated by breech presentation and amnionitis. The baby was noted to have multiple congenital anomalies and expired 5 hours postpartum. Postmortem examination demonstrated imperforate anus, bilateral renal hypoplasia with right uretero~ pelvic junction obstruction, Potter's facies, choledochal cyst, imperforate vagina, urachal cyst, and a colon that ended blindly against the dorsal aspect of the latter. Several mesenteric bands surrounded a distal loop of dilated sigmoid colon. Specimen radiographs of the meconium within the loop demonstrated scattered calcifications. No connection between the urachal sac and colon was identified. The infant's karyotype was 46,XX. An abdominal radiograph performed after expiration identified scattered left hemiabdominal calcifications confined to a focally dilated loop of colon (Fig. 2).Case 2 A 33~year-old gravida 1, para 0 woman with no significant medical history was suspected of carrying a growthretarded fetus. Sonography demonstrated a 32-week gestation. The fetal abdomen contained multiple coarse hyperechoic foci within dilated loops of bowel (Fig. 3). Active peristalsis of these loops was observed. A fetal sonogram 3 weeks later demonstrated normal interval growth and multiple coarse intra-abdominal calcifications confined to the dilated bowel that measured 4.5 em in diameter in the periphery of the fetal abdomen. A 2,296-g boy was delivered by cesarean section following a nonreactive stress test. Apgar scores were 9 and 9. Neonatal evaluation demonstrated imperforate anus, hypospadias, rectovesical fistula, malpositioned thumbs, and mul-

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“…Several authors have reported intraluminal meconium calcification in neonates with distal intestinal obstruction [1][2][3][4][5][6][7][8][9][10][11]. The underlying disorders include: imperforated anus [1,2]; persistent cloaca [3]; multiple gastrointestinal atresias [4][5][6][7]; small bowel stenosis [8]; total colonic angaglionosis [9,10]; and "functional ileal obstruction" [11].…”

mentioning

confidence: 99%

“…The underlying disorders include: imperforated anus [1,2]; persistent cloaca [3]; multiple gastrointestinal atresias [4][5][6][7]; small bowel stenosis [8]; total colonic angaglionosis [9,10]; and "functional ileal obstruction" [11].…”

mentioning

confidence: 99%