Rolle Udo, Faber Renaldo, Robel-Tillig Eva, Muensterer Oliver, Hirsch Wolfgang, Till Holger
Department of Paediatric Surgery, University of Leipzig, 04317 Leipzig, Germany.
J Pediatr Surg. 2008 Apr;43(4):e11-3. doi: 10.1016/j.jpedsurg.2007.11.030.
Extraluminal calcified meconium is found frequently by prenatal ultrasound in cases with bowel perforation and meconium peritonitis. Intraluminal intestinal meconium calcifications are rarely seen in prenatal sonography. Meconium calcifications result from a mixture of meconium and urine that indicates a connection between intestinal and urinary tract. We report a case of a male newborn prenatally diagnosed with intraluminal echogenic calcifications at 23 weeks of gestation, suggesting an anorectal malformation (ARM) with rectourinary fistula. At birth, the child presented with a complex ARM including high anal atresia with both perineal and rectourethral fistula. Furthermore, a bladder outlet obstruction due to a urethral stenosis was diagnosed. Vesicostomy was performed as an emergency procedure followed by colostomy during neonatal period. Posterior sagittal anorectoplasty was performed at the age of 4 months. Prenatal echogenic calcifications within bowel should raise the suspicion of ARM with rectourinary fistula and bladder outlet obstruction.
在肠穿孔和胎粪性腹膜炎病例中，产前超声经常发现管腔外钙化胎粪。产前超声很少见到管腔内肠胎粪钙化。胎粪钙化是由胎粪和尿液混合形成的，这表明肠道和泌尿道之间存在联系。我们报告一例男性新生儿，在妊娠23周时产前诊断为管腔内强回声钙化，提示患有伴有直肠尿道瘘的肛门直肠畸形（ARM）。出生时，患儿表现为复杂的ARM，包括高位肛门闭锁伴会阴瘘和直肠尿道瘘。此外，诊断出由于尿道狭窄导致膀胱出口梗阻。紧急进行膀胱造瘘术，随后在新生儿期进行结肠造瘘术。4个月大时进行了后矢状位肛门直肠成形术。肠道内产前强回声钙化应引起对伴有直肠尿道瘘和膀胱出口梗阻的ARM的怀疑。
