Isolated fetal ascites as a presentation of intestinal atresia

Abstract

Isolated fetal ascites is a rare condition and its natural history needs further research. We describe a case of progressive fetal isolated ascites diagnosed at 22 weeks of gestation associated with hyperechogenic bowel in a primiparous woman. Genetic abnormalities, infection and metabolic causes were excluded. An elective C-section was performed at 29 weeks of gestation after no clinical improvement was obtained with paracentesis. After birth, X-ray and ultrasonography showed high-volume ascites and enlarged liver. On the 5th day of life, no meconium had passed and an abdominal X-ray was repeated: pneumoperitoneum was diagnosed. Laparotomy identified intestinal atresia type IIIB associated with meconial peritonitis and a derivative jejunostomy was performed. There were complications caused by late-onset sepsis and necrotizing enterocolitis. Reconstruction of jejunostomy was successfully performed on day 114. At 15 months of age, the infant is in good health and has normal psychomotor development.

Keywords

• intestinal atresia
• ascites
• echogenic bowel
• peritonitis
• pneumoperitoneum
• preterm infant