Connatal Urinary Ascites in a Female Preterm

Area of Science:

• Neonatalogy
• Fetal Medicine
• Pediatric Surgery

Background:

• Congenital urinary ascites is a rare condition in female infants, typically associated with bladder rupture and often presenting with other malformations.
• Maternal health complications during pregnancy, such as viral pneumonia requiring intensive care, can impact fetal development and lead to rare conditions.

Observation:

• A very preterm female infant developed significant isolated ascites, diagnosed via serial fetal ultrasound revealing megacystis.
• Postnatal drainage confirmed the ascites was of urinary origin.
• A bladder leak was visualized using instilled blue dye, which appeared in the ascitic fluid via a Foley catheter.

Findings:

• The case demonstrates fetal bladder rupture leading to congenital urinary ascites in a female neonate, with a suspected link to maternal pneumonia and intensive care.
• The infant experienced spontaneous micturition post-catheter removal, and a micturating cystourethrogram confirmed spontaneous closure of the bladder leak.
• Instillation of blue dye proved to be an effective, non-radiographic method for diagnosing the bladder leak.

Implications:

• This case highlights the importance of considering maternal health factors in the etiology of fetal anomalies.
• The use of blue dye offers a valuable, safe, and accessible diagnostic tool for urinary leaks in preterm neonates, avoiding the need for contrast radiography.
• Early diagnosis and management of congenital urinary ascites can lead to favorable outcomes, even in preterm infants.