A case of fetal duodenal atresia suspected to be lower urinary tract obstruction

Excerpt

A 35 year-old woman, gravida 2, para 1, who was pregnant following in vitro fertilization, was referred for a suspected fetal lower urinary tract obstruction at 16 weeks of gestation. Transabdominal ultrasonography at 16 weeks of gestation revealed a large cyst in the fetal abdominal cavity, with a single umbilical artery running along the right side of the cyst (Fig. 1a). Transabdominal ultrasonography at 17 weeks of gestation revealed the large cyst and another smaller cyst in the fetal abdominal cavity adjacent to the stomach (Fig. 1b). Although the amniotic fluid volume was normal, hydronephrosis was also detected; the large cyst was suspected to be the bladder (Fig. 1b). The “key-hole sign” was not detected in the large cyst. Pregnancy was terminated at 19 weeks of gestation after counseling. Autopsy findings revealed multiple atresia of the pylorus and the duodenal–jejunal transition zone, duodenal dilatation, asplenia, intestinal malrotation, endocardial defect, bilateral lungs with three lobes, anal atresia, vaginal atresia, and a single umbilical artery. The pyloric atresia was disconnected, and the duodenal–jejunal transition zone atresia was a membranous closure (Fig. 1c, d). A bile reservoir was also observed in the duodenal dilation. Autopsy findings showed that the small cyst and the large cyst detected on fetal ultrasound were the bladder and the duodenal dilation, respectively.

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