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The prenatal diagnosis of imperforate anus with rectourinary fistula: dilated fetal colon with enterolithiasis
J Mandell1, C W Lillehei, M Greene
1Division of Urology, Children's Hospital; Boston, MA 02115.
Insights
Intraluminal meconium calcifications, a rare finding, suggest a rectourinary fistula when seen with dilated intestines and urinary issues. This study reports two prenatal cases of imperforate anus with rectourinary fistulae.
Area of Science:
- Medical Imaging
- Pediatric Surgery
- Neonatal Medicine
Background:
- Extraluminal calcifications typically indicate intrauterine intestinal perforation and meconium extravasation, often linked to obstruction or atresias.
- Intraluminal meconium calcification is a rarer finding with distinct prenatal diagnostic implications.
Observation:
- Intraluminal calcifications within a dilated intestinal loop, especially with concurrent urinary tract abnormalities, are key indicators.
- These findings suggest the mixing of stagnant urine and meconium in utero.
Findings:
- The study reports two cases of prenatally diagnosed imperforate anus.
- Both cases presented with rectourinary fistulae, a condition suggested by intraluminal calcifications.
Implications:
- Prenatal diagnosis of intraluminal calcifications can guide the identification of rectourinary fistulae.
- Early detection of imperforate anus and associated fistulae is crucial for timely neonatal surgical intervention.
Abstract:
The finding of extraluminal calcifications is commonly reported and usually indicates intrauterine intestinal perforation with intraperitoneal extravasation of meconium, most often associated with intestinal obstruction and/or atresias. Intraluminal calcification of meconium is more rare and appears to result from the mixing of stagnant urine and meconium in utero. The presence of the intraluminal calcifications in a dilated loop of intestine, particularly with an associated urinary tract abnormality, should suggest a rectourinary fistula. Two cases of prenatally diagnosed imperforate anus with rectourinary fistulae are reported.