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Congenital chloride diarrhoea: a prenatal differential diagnosis of small bowel atresia
K Lundkvist1, U Ewald, P G Lindgren
1Department of Paediatric Surgery, Uppsala University Hospital, Sweden.
Insights
Prenatal ultrasound can help distinguish congenital chloride diarrhea from small bowel atresia. Congenital chloride diarrhea presents with polyhydramnios and specific fetal intestinal findings, unlike small bowel atresia.
Area of Science:
- Medical imaging
- Fetal medicine
- Pediatric surgery
Background:
- Congenital chloride diarrhea and small bowel atresia are rare neonatal conditions.
- Accurate prenatal diagnosis is crucial for optimal management.
- Distinguishing between these conditions prenatally can be challenging.
Purpose of the Study:
- To identify distinguishing prenatal ultrasound markers for congenital chloride diarrhea versus small bowel atresia.
- To evaluate the efficacy of ultrasound in differentiating these two fetal gastrointestinal anomalies.
Main Methods:
- Retrospective comparison of ultrasound findings in 8 patients with congenital chloride diarrhea and 14 with small bowel atresia.
- Analysis of pre- and postnatal clinical signs.
- Correlation of imaging findings with confirmed diagnoses.
Main Results:
- Congenital chloride diarrhea cases showed marked polyhydramnios and increased symphysis-fundus distance (> +2 SD before 31 weeks).
- Fetal ultrasound in congenital chloride diarrhea revealed normal peristalsis in extensively dilated intestines and a "frog position".
- Small bowel atresia cases had normal symphysis-fundus distance before 31 weeks and increased peristalsis in few dilated loops.
Conclusions:
- Specific ultrasound findings, including polyhydramnios, symphysis-fundus measurements, and fetal intestinal motility patterns, can aid in differentiating congenital chloride diarrhea from small bowel atresia prenatally.
- Ultrasound is a valuable tool for prenatal diagnosis of these conditions.
Abstract:
We compared ultrasound findings and pre- and postnatal clinical signs in 8 patients with congenital chloride diarrhoea and 14 with small bowel atresia diagnosed in 1977-1991 in order to evaluate the possibility of a prenatal distinguishing diagnostic sign. In the patients with congenital chloride diarrhoea the pregnancy was complicated by marked polyhydramnios, the symphysis-fundus distance exceeded + 2 SD before gestational week 31 and the fetus displayed normal peristalsis in extensively dilated intestines and the "frog position". In the patients with small bowel atresia the symphysis-fundus distance was normal before gestational week 31 and the fetus displayed increased peristalsis in a few dilated intestinal loops.