Prenatal diagnosis of intestinal atresia

We present an unusual case in which diagnosis was made shortly after bowel perforation at 33 weeks of gestation and definitive surgery was performed following prompt Caesarean delivery.
A 33-year-old woman, gravida 3 para 2, was referred to our center at 33 weeks of gestation because of antenatal control. Ultrasound examination at admission showed presence of an cystic structure in the fetal abdomen, that was consistent with intestinal dilatation. The fetal growth parameters, placental structure and amniotic fluid volume were all normal. Detailed ultrasound examination of fetal anatomy revealed no additional abnormalities. One week later repeat ultrasound scan showed collapse of the bowel dilatation along with the presence of hyperechogenic fluid in the fetal abdominal cavity. Both parents were counseled regarding the possible diagnosis of fetal intestinal perforation and meconium peritonitis. Caesarean section was preferred as delivery mode due to previous Caesareans. A 2400 gram baby boy was delivered. Apgar scores were 8 and 9 at 1 and 5 min, respectively. Laparotomy and bowel resection were performed within the first day following delivery. The operative findings were atresia of terminal ileum, with a perforation in the distal segment of it, and intraabdominal meconium.
It is not clear appropriate delivery time and treatment modality after prenatal identification of the problem. But meconium contains digestive enzymes that induce aseptic peritonitis. Extensive inflammation could inhibit spontaneous sealing of the perforation and inflammation-induced bowel edema could aggravate the underlying bowel obstruction. Morbidity and mortality in meconium peritonitis cases depend upon gestational age, the complexity and the nature of the underlying lesion, process interval, presence of the cystic fibrosis or congenital anomalies, and complications of treatment or expectant management.

Keywords

Intestinal atresia, Meconium peritonitis

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	Figure 1 Cystic dilatation of bowel