Echogenic foci in the dilated fetal colon may be associated with the presence of a rectourinary fistula

Pohl-Schickinger, A.; Henrich, Wolfgang; Degenhardt, P.; Bassir, C.; Hüseman, D.

doi:10.1002/uog.2852

Cited by 29 publications

(25 citation statements)

References 24 publications

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“…The use of prenatal ultrasound to identify intraluminal calcifications and to differentiate between enterolithiasis and meconium peritonitis was described in 1988 (4,5). The sonographic sign of enterolithiasis is a dilated loop of bowel containing calcified foci, as found in our case.…”

Section: Discussionmentioning

confidence: 97%

“…The sonographic sign of enterolithiasis is a dilated loop of bowel containing calcified foci, as found in our case. Enterolithiasis is a rare prenatal ultrasound finding and raises the possibility of an urodigestive fistula, although the fistula cannot be demonstrated antenatally (2,4). Intraluminal calcifications of the rectum have been reported as a mark of imperforate anus (2,(4)(5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 97%

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Second trimester diagnosis of imperforate anus

Mhabrech

Zrig

Ksiaa

et al. 2015

The Egyptian Journal of Radiology and Nuclear Medicine

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Imperforate anus or anorectal atresia is often associated with major fetal structural defects but it may also be an isolated abnormality. Prenatal diagnosis is difficult but may be assisted by ultrasound detection of enterolithiasis in dilated bowel and confirmed by MRI study. We report a case of imperforate anus in which enterolithiasis with dilated bowel was detected by ultrasound examination at 25 weeks of gestation and confirmed by MRI examination. At birth, the newborn was diagnosed to have a low type of imperforate anus.A 26-year-old woman gravida 2 para 2 presented to the ultrasound unit at 25 weeks of spontaneous gestation for routine screening. Ultrasound examination using Esaoti (MyLabSIX) machine equipped with 7-10-MHz probes, revealed dilated bowel with intraluminal circular hyperechogenic structures associated with single umbilical artery. No other malformation could be depicted on ultrasound study. Follow-up ultrasound examinations at 28 weeks gestation showed progressive dilatation of bowel and persistence of intraluminal echogenic foci (Fig. 1). MRI examination, was performed on GE 1.5 Tesla superconducting magnet. Axial T1 W images are obtained using 256 · 160 matrix, 48 cm field of view (FOV), 4 mm slice thickness, 2 mm interslice gap, and 1 number of excitation (NEX). High-resolution T2 W images of pelvis are acquired in axial, sagittal, and coronal planes using 256 · 256 matrix, 48 cm FOV, 4 mm slice thickness, 0.4 mm interslice gap, and 0.53 NEX.MRI confirmed at 32 weeks of gestation dilated bowel loops and detected rectal obstruction. The rectal cul-de-sac was located at a level lower than the level of the bladder neck, confirming low anorectal malformation (Fig. 2a) with abnormal and heterogeneous fluid signal on T1 and T2 weighted images: the usual hyperintensity on T1 and hypointensity on T2 of meconium was not identified (Fig. 2b). The urinary bladder was normal. A 3150 g male was born spontaneously at 35 weeks of gestation, with Apgar score (healthy infant score) of 8/9. Esophageal continuity had been confirmed by passing 8 cm red rubber catheter into the stomach. Physical examination revealed an absence of an anal opening and a massively distended abdomen. The abdominal radiograph demonstrated a cluster of multiple calcified shadows, cardiomegaly, and left side pneumothorax associated with right pulmonary hypoplasia (Fig. 3). Abdominal ultrasound confirmed the dilated small and large bowels. Echocardiography done after Abbreviation: ARM, anorectal malformation

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Second trimester diagnosis of imperforate anus

Mhabrech

Zrig

Ksiaa

et al. 2015

The Egyptian Journal of Radiology and Nuclear Medicine

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“…Rectovesical or rectourethral fistula typically occurs in patients with an anorectal malformation such as imperforate anus [23,24] . Neonates with rectourinary fistula may develop enterolithiasis due to mixing of meconium and urine [23,24] .…”

Section: Rectourinary Fistulamentioning

confidence: 99%

“…Neonates with rectourinary fistula may develop enterolithiasis due to mixing of meconium and urine [23,24] . Enterolithiasis appears as calcifications on radiographs, and can be further evaluated with high-frequency, high-resolution real time ultrasound to confirm intraluminal location and distinguish this entity from meconium peritonitis [24] ( Figure 2).…”

Section: Rectourinary Fistulamentioning

confidence: 99%

“…Enterolithiasis appears as calcifications on radiographs, and can be further evaluated with high-frequency, high-resolution real time ultrasound to confirm intraluminal location and distinguish this entity from meconium peritonitis [24] ( Figure 2). Enterolithiasis can also be seen in other cases of intestinal obstruction such as ileal stenosis, jejunal atresia, and functional obstruction of the ileum [23,24] . Transperineal ultrasonography can also be performed in patients with anal atresia to identify the internal fistula [25] .…”

Section: Rectourinary Fistulamentioning

confidence: 99%

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Abdominal ultrasonography of the pediatric gastrointestinal tract

Gale¹,

Gee²,

Westra³

et al. 2016

WJR

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Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.

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First trimester expression of anorectal malformation: Case report and review of the literature

Liberty

Bardin

Gilboa

et al. 2018

J of Clinical Ultrasound

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A 26-years-old woman, underwent an ultrasound examination at 13.4 weeks. A cystic structure was identified in the right lower abdomen. Gradually, the cystic mass was replaced by echogenic content and eventually attained the appearance of hyperechoic bowel. At 21.2 weeks, the anal sphincter could not be demonstrated which was consistent with the diagnosis of isolated anal agenesis. Amniocentesis revealed 46XY karyotype with normal comparative genomic hybridization. After termination of pregnancy at 23 weeks, an autopsy revealed an isolated high type anorectal malformation (ARM) without fistula. We reviewed all 14 cases reported in the literature of first trimester sonographic expression of ARM.

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Echogenic foci in the dilated fetal colon may be associated with the presence of a rectourinary fistula

Abstract: Intraintestinal meconium calcification in the fetus

Cited by 29 publications

References 24 publications

Second trimester diagnosis of imperforate anus

Second trimester diagnosis of imperforate anus

Abdominal ultrasonography of the pediatric gastrointestinal tract

First trimester expression of anorectal malformation: Case report and review of the literature

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