Ultrasonographic detection of intrauterine intussusception resulting in ileal atresia complicated by meconium peritonitis

Abstract

A neonate with ileal atresia (IA) complicated by meconium peritonitis (MP) whose prenatal ultrasonography (US) detected an intrauterine intussusception (IUI) is reported. Fetal ascites, dilated bowel loops, and abdominal calcifications were identified on serial US from 25 weeks of gestation. Intestinal loops with high echogenecity and a "target-like" appearance suggestive of IUI were detected in the right lower quadrant. The 2,680-g male was delivered vaginally at term and underwent a laparotomy. Fibrous adhesions and small calcifications were scattered throughout the peritoneal cavity. IA (interrupted type) was confirmed 17.0 cm cranial to the ileocecal valve (ICV). An ileo-ileal intussusception was also found between 16.5 cm and 9.0 cm cranial to the ICV. Partial resection of the ileum and an ileo-ileal anastomosis was performed. The postoperative course was uneventful. In this case, the pathological process of IUI resulting in IA and MP was demonstrated sonographically by identifying the "target-like" appearance in the fetus.

Fetal intra‐abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery

“…Review of the literature on the subject revealed 19 articles fulfilling the inclusion criteria (detailed description of ultrasound findings as well as correlation between the prenatal ultrasonographic patterns and clinical outcome), for a total of 56 additional cases (Estroff et al, 1992;Shyu et al, 1994;Konje et al, 1995;Yang et al, 1997;Ohmichi et al, 1997;Patole et al, 1998;Chitayat et al, 1998;Chalubinski et al, 1992;Reynolds et al, 2000;Seow et al, 2000;Shimotake et al, 2000;Leung et al, 2001;Pan et al, 2002;Mendez et al, 2003;Shyu et al, 2003;Chen et al, 2004;Amagada et al, 2004;Agboola et al, 2004;Piolat et al, 2005). Of the 19 articles, 13 were case reports (Shyu et al, 1994;Konje et al, 1995;Yang et al, 1997;Ohmichi et al, 1997;Patole et al, 1998;Reynolds et al, 2000;Seow et al, 2000;Shimotake et al, 2000;Mendez et al, 2003;Chen et al, 2004;Amagada et al, 2004;Agboola et al, 2004;Piolat et al, 2005). To establish a correlation between antenatal findings and postnatal outcome, we divided the total 69 cases, including our series, into four grades: (1) grade 0: isolated intra-abdominal calcifications (n = 18), (2) grade 1: intra-abdominal calcification and ascites (n = 17) or pseudocyst (n = 2), or bowel dilatation (n = 6), (3) grade 2: two associated findings (n = 20), and (4) grade 3: all sonographic features (n = 6) (Table 1 and Figure 1).…”

Intrauterine intussusception: a rare cause of intestinal atresia

“…Although intrauterine intussusception has been described as dilatation of bowel loops [4], ascites with intraabdominal calcifications in perinatal ultrasound [5,6] or after carrying out a gastrografin enema before surgery [7], the definitive diagnosis is usually made after operating on a neonate with bowel occlusion and finding a jejunoileal atresia whose distal segment contains a polypoid protrusion [8,9], as our case demonstrates clearly.…”

Antenatal sonographic features of ileal atresia

“…Although the duodenum is the most common site, the jejunum and ileum account for 39% of cases of intestinal atresia 1 . Reports of prenatally‐diagnosed ileal atresia consist of case reports and small series, with sonographic detection typically occurring late in the third trimester 6–11 . Of our cases, 56.3% were antenatally‐diagnosed and all antenatally‐diagnosed cases were detected in the third trimester.…”

“…1 Reports of prenatally-diagnosed ileal atresia consist of case reports and small series, with sonographic detection typically occurring late in the third trimester. [6][7][8][9][10][11] Of our cases, 56.3% were antenatally-diagnosed and all antenatallydiagnosed cases were detected in the third trimester. The diagnosis of ileal atresia may be difficult because most cases are not apparent until the third trimester and the sonographic features are not unique.…”