Prenatal diagnosis of fetal bowel obstruction complicated by in utero acute intestinal perforation.

Abstract

A 33 year old primigravid woman attended the Fetal Unit of our hospital at 21 weeks of gestation for prenatal examination. An ultrasound scan showed a single anechoic cystic mass measuring 3 cm in diameter (3 3 cm) in the abdomen of the fetus, with no dilatation of other parts of the intestine. At 25 weeks, an ultrasound scan showed distended bowel loops with decrease in size of the fluidfilled lesion seen on the first scan. At 32 weeks of gestation, the cystic mass could not be seen but the bowel distension had increased. Magnetic resonance imaging showed dilated fluid-filled intestinal loops (Fig. 1) and the site of intestinal atresia. The colon and the small intestine beyond the atresia were normal. At 35 weeks of gestation, an ultrasound scan showed a decrease in size of the dilated loops, moderate fetal ascites, absence of peristalsis and echogenic material outside the bowel. All these findings suggested intrauterine intestinal perforation. An elective caesarean section was performed at 35 weeks of gestation. A baby boy was born weighing 2800 g. He had abdominal distension and moderate scrotal swelling. The infant underwent a transverse laparotomy immediately after delivery. An ileal perforation was seen proximal to an atretic segment of bowel (ileal atresia type II) (Fig. 2). Meconium peritonitis was confirmed. The bowel walls showed mild inflammation without ischaemic changes consistent with a recent intestinal perforation. A primary ileostomy was performed with resection of 5 cm of distended ileum. His post-operative course was uneventful and intestinal continuity was restored by end-to-end anastomosis 14 days after the first surgical procedure. The baby started oral feeds seven days after the second operation. During this period, he received total parenteral nutrition. The boy is now 15 months old and has no problems.