Prenatal sonographic findings in a fetus with congenital isolated ileal atresia.
ABSTRACT Most cases of isolated nonduodenal bowel atresia are thought to be due to ischemic events from hypotension, vascular accident, volvulus, intussusception and cocaine. We present a case of isolated ileal atresia suggested using results of prenatal sonography which showed multiple markedly dilated fluid-filled intestinal loops with changeable shapes and positions secondary to active peristalsis. Postnatal oral contrast radiography demonstrated obstruction located at the ileal level. Exploratory laparotomy confirmed isolated ileal atresia. Primary end-to-end anastomosis was done. The infant endured the procedure well. Cases with multiple intestinal atresia always have fatal prognosis, even after surgery. Cases of isolated intestinal atresia usually have better prognosis and deserve more attention. Early diagnosis and early intervention are both important for good outcomes.
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ABSTRACT: The purpose of this study was to determine the antenatal sonographic features of ileal atresia. We identified neonates with surgically-confirmed ileal atresia who had antenatal sonography performed in our institution between 1 January 1999 and 30 June 2009. The antenatal sonography images and reports were reviewed. Sixteen neonates had surgically-confirmed ileal atresia in our institution in 11 years. Seven fetuses (43.7%) did not have any intestinal abnormalities detected antenatally on ultrasonography. Nine fetuses (56.3%) had various sonographic features of ileal atresia, including multiple dilated bowel loops, ascites, cysts, and polyhydramnios with or without associated anomalies. Six of nine fetuses had multiple dilated bowel loops and two fetuses had ascites. One fetus had a large, cystic, mixed, echogenic dilatation of bowel. Polyhydramnios was present in three fetuses. Heart anomalies, kidney anomalies, or hydrops were present in four fetuses. Eight of 16 fetuses (50%) had other intestinal problems, including intussusceptions in one fetus, small bowel malrotation, meconium pseudocyst volvulus, meconium peritonitis, and a congenital band. The prenatal sonographic features of ileal atresia are not simple. Various sonographic findings are shown and ileal atresia was detected in about 60% of cases.Journal of Obstetrics and Gynaecology Research 01/2012; 38(1):215-9. · 0.84 Impact Factor
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ABSTRACT: A 36-year-old multigravida, G2P1, underwent routine ultrasound scan at 22+1 weeks of gestation, which revealed a single normally growing fetus with left intrathoracic mass and left displacement of the cardiac apex. The left intrathoracic wedge-shaped hyperechogenic mass, measuring 32 x 25 mm in size, was situated at the lower portion of the left lung. A combination of color and power Doppler ultrasound allowed visualization of a vessel arising from the descending aorta, which supplied the mass. The diagnosis of extralobar pulmonary sequestration was made. Magnetic resonance imaging (MRI) was also performed and revealed a well-defined mass with homogeneous high-signal intensity when compared with normal lung tissue in the left upper lung field, which was compatible with pulmonary sequestration. The pulmonary mass was followed up by color and power Doppler every 2 weeks. The peak velocity of 11.85 cm/sec and the diameter of the feeding artery of 1.19 mm gradually decreased and disappeared 8 weeks later. The intrathoracic mass disappeared 10 weeks later at 32+1 gestational weeks. Repeat MRI also revealed spontaneous regression of the mass in favor of resorption of sequestration. The fetus was delivered at 38+1 gestational weeks. A male newborn weighing 2,520 g was spontaneously delivered with an Apgar score of 8 at 1 minute and 9 at 5 minutes. In our patient, it is suggested that progressive decreases in the peak velocity of the feeding vessel heralded the spontaneous regression of pulmonary sequestration not associated with hydrops/hydrothorax.Journal of the Chinese Medical Association 02/2008; 71(1):53-7. · 0.75 Impact Factor
mately 2 to 3 in 10,000 births.2Jejunoileal atresia usu-
ally occurs more frequently than duodenal atresia. Mul-
tiple atresias are found in 7 to 20% of cases.1,3A few
cases of intestinal atresia with detailed descriptions of
prenatal sonographic findings have been reported.4-9
We present a case of isolated ileal atresia suggested by
results of prenatal sonography and confirmed by
postnatal radiographs with successful surgery. We also
discuss the clinical significance by reviewing recent re-
ports in the literature.
tresias are the most common congenital anoma-
lies of the midgut.1The incidence is approxi-
A23-year-old primigravida at 36 4/7 weeks of ges-
tation was referred with suggestion of fetal anomalies.
Prenatal sonography (Acuson, Aspen, CA, USA) re-
vealed a relatively enlarged fetal abdomen caused by
multiple markedly dilated fluid-filled loops with active
peristaltic movements (Fig. 1). The maximal diameter
obvious signs of dilated rectum or colon were identified.
Distal small intestine obstruction was suggested. No
other anomalies were found, including polyhydramnios,
organs (heart, kidney, liver, head and bones). Color
Doppler showed normal umbilical artery and ductus
venosus flow. After counseling, a 2964-g male infant
was delivered by cesarean section due to malpresentation
2 days after sonography. Apgar scores were 7 and 8 at 1
and 5 minutes, respectively. The chromosomal study
showed 46, XY. Abdominal distension was noted and
greenish bile-like materials were sucked fromthe stom-
ach. Oral contrast radiographs demonstrated distended
bowels, which suggested obstruction at the ileal level
(Fig. 2). Exploratory laparotomy on the third day
postpartum revealed an isolated ileal atresia, about 45
cm proximal to the ileocecal valve (Fig. 3). After cut-
ting 2 blind ends (about 20 cm in length) and tapering
the proximal dilated ileum, end-to-end primary anasto-
mosis was performed. Meconium and contrast medium
were passed on the second post-operative day. The in-
J Chin Med Assoc
1Department of Obstetrics and
Gynecology, Department of Radiology,
2Division of Pediatric Surgery, Veterans
General Hospital-Kaohsiung, Kaohsiung,
isolated ileal atresia;
Prenatal Sonographic Findings in a Fetus
with Congenital Isolated Ileal Atresia
Most cases of isolated nonduodenal bowel atresia are thought to be due to ischemic
events from hypotension, vascular accident, volvulus, intussusception and cocaine.
We present a case of isolated ileal atresia suggested using results of prenatal
sonography which showed multiple markedly dilated fluid-filled intestinal loops
with changeable shapes and positions secondary to active peristalsis. Postnatal oral
contrast radiography demonstrated obstruction located at the ileal level. Exploratory
laparotomy confirmed isolated ileal atresia. Primary end-to-end anastomosis was
ways havefatal prognosis, evenafter surgery. Casesof isolatedintestinalatresiausu-
ally have better prognosis and deserve more attention. Early diagnosis and early in-
tervention are both important for good outcomes.
Received: August 18, 2003.
Accepted: December 18, 2003.
Correspondence to: Fu-Nan Cho, MD, Department of Obstetrics and Gynecology, Veterans General
Hospital-Kaohsiung, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
Fax: +886-7-346-0284; E-mail: firstname.lastname@example.org
fant endured the procedure well and was discharged 2
weeks after surgery.
The embryonic origins are different for duodenal
atresia and jejunoileal atresia. Duodenal atresia results
from failure of recanalization of lumen before the 10th
gestational week.1,10Some genetically determined fac-
tors may act to induce the transition from solid stage to
hollow stage. Autosomal recessive gene and trisomy 21
are partially responsible for the duodenal atresia.2,10
Most cases of isolated nonduodenal bowel atresia are
thought to be due to ischemic events from hypotension
(due to “brain-sparing” effect in the fetus), vascular ac-
cident, volvulus, intussusception and cocaine.2The
events resulting in ischemic necrosis of a segment of
the intestine may develop after the onset of fetal swal-
lowing, so that meconium may be present in the distal
bowel beyond the atresia.1Hereditory multiple intesti-
nal atresia has been associated with autosomal reces-
sive genetic syndromes including cystic fibrosis.2,4-6,11
Intestinal atresia can be classified into 4 types.12Type I
atresia is caused by a luminal diaphragm with continu-
ing outer muscular layer. In type II, the 2 blind ends of
the bowel are attached by a fibrous cord. Type III
Prenatal Sonographic Findings in Isolated Ileal Atresia
Fig. 1. Multiple dilated fluid-filled intestinal loops (I) pre-
sented with changeable shapes and positions secondary to
active peristalsis. (A) transverse view, (B) longitudinal
view. L = liver, H = heart.
Fig. 2. Oral contrast radiograph showed the markedly di-
lated small intestine (arrows) at the ileal level.
Fig. 3. Intraoperative photograph showed isolated type III
atresia with complete defect (arrow head) between the di-
lated proximal ileum (large arrow) and the small distal il-
eum (small arrow).
atresia is complete separation of the bowel ends. Type
fect. Type IIIb atresia is referred to apple-peel atresia.
Multiple atresia is classified as type IV. Our case was
Differential diagnosis of fetal abdominal cysts
should include origins from the ovary, urinary organ,
hepatic-biliary organ and intestine. Multiple cysts with
obvious peristalsis inclined the consideration of intesti-
nal lesions. More loops dilated usually means more dis-
tal obstruction and less severity of the polyhydramnios.
Absent signs of dilated rectum or colon in our case ex-
cluded the possibility of imperforate anus. Intestinal
volvulus often presents as a whorl-like cystic mass and
fixed dilated loops arranged in 2 to 3 parallel seg-
ments.13Isolated ileal atresia in our case showed multi-
ple markedly dilated fluid-filled loops with active peri-
staltic movements. The loops were shown communicat-
ing after careful tracing of the course of the dilated
loops using real-time ultrasound. Previous report has
mentioned the possibility that torsion of dilated bowel
may occur.7Congenital isolated ileal atresia has been
reported as a single cyst-like lesion due to the incom-
plete torsion of the dilated proximal small bowel.8Late
detection may lead to intestinal necrosis, resulting in
meconium peritonitis. However, the findings in our
case were different.
Patients with multiple intestinal atresia always
have poor prognoses, even after surgery.6,11Cases with
prenatally closed gastroschisis always suffer from ex-
tended intestinal atresia from the jejunum to the proxi-
mal transverse colon and lead to death.14Those with
especially when located at more distal portion, diag-
nosed prenatally and managed prior to the development
of severe distention or perforations of bowels. Accord-
ingly, isolated intestinal atresia deserves more atten-
tion. The favorable prognosis in our case resulted from
the absence of meconium peritonitis, meconium ileus,
malrotation, polyhydramnios, abnormal chromosome
and other congenital anomalies. Early obstetric inter-
vention, successful pediatric surgery and meticulously
intensive care of the newborn also helped achieve the
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3. Cywes S, Davies MRQ, Rode H. Congenital jejuno-ileal
atresia and stenosis. S Afr Med J 1980;57:630-9.
4. SkollMA,Marquette GP, Hamilton EF. Prenatal ultrasonic di-
agnosis of multiple bowel atresias. Am J Obstet Gynecol
5. Boyd PA, Chamberlain P, Gould S, Ives NK, Manning N,
Tsang T. Hereditary multiple intestinal atresia-ultrasound
findingsandoutcomeofpregnancy inanaffected case. Prenat
6. Cho MM, Tseng JJ, Ho Esther SC, Peng HC. In utero
sonographic findings in a fetus with a hereditary multiple in-
testinal atresia. J Chin Med Assoc 2002;65:131-4.
7. Miyakoshi K, Tanaka M, Miyasaki T. Prenatal ultrasound di-
agnosis of small bowel torsion. Obstet Gynecol 1998;91:
8. AkioK,Tsuyoshi N,TakeoY.Congenital ileal atresia present-
ing as a single cyst-like lesion on prenatal sonography. J Clin
9. Benachi A, Soniogo P, Jouannic J. Determination of antenatal
intestinal occlusion by magnetic resonance imaging. Ultra-
sound Obstet Gynecol 2001;18:163-5.
10. Mishalany HG,IdrissZH,DerKaaloustianVM.Pyloroduodenal
atresia (diaphragm type): an autosomal recessive disease. Pe-
11. Gungor N, Balci S, Tanyel FC, Cogus S. Familial intestinal
polyatresia syndrome. Clin Genet 1995;47:245-7.
12. Grosfeld JL, Ballantine TVN, Shoemaker R. Operative man-
agement of intestinal atresia and stenosis based on pathologic
findings. J Pediatr Surg 1979;14:369-72.
13. Uerpairojkit B, Charoenvidhya D, Tanawattanacharoen S,
Manotaya S, Wacharaprechanont T, Tannirandorn Y. Fetal in-
testinal volvulus: a clinico-sonographic finding. Ultrasound
Obstet Gynecol 2001;18:186-7.
14. Basaran UN, Inan M, Gucer F,Yardim T, Pul M. Prenatally
closed gastroschisis with midgut atresia. Pediatr Surg Int
Fu-Nan Cho et al. Journal of the Chinese Medical Association Vol. 67, No. 7