2015 Volume 28 Issue 2 Pages 164-168
We treated a case of concurrent obstructive lower urinary tract disease and esophageal atresia for which oligohydramnios was not observed until the third trimester of pregnancy. The patient was a 1-year-old boy in whom severe bilateral hydroureteronephrosis and bladder distension were detected at 21 weeks of intrauterine life, raising suspicion of lower urinary tract obstruction. However, amniotic fluid volume was maintained, so follow-up observations were conducted with no active treatment. From 36 weeks of gestation, oligohydramnios was observed, and the patient was delivered at 37 weeks after labor induction. Postnatally, he was diagnosed with esophageal atresia and urethral hypoplasia was suspected due to a pinhole-shaped urethral meatus. Postnatal imaging revealed severe bilateral hydroureteronephrosis and vesicoureteral reflux. Failure of the functioning of the right kidney was also observed. In fetuses with nephrourinary malformations, oligohydramnios suggests renal failure and is an indicator for terminating pregnancy. In the present case, concurrent esophageal atresia delayed the onset of oligohydramnios, and the renal failure may have progressed because the period for pregnancy termination had been exceeded. When determining renal function in fetuses with the possibility of lower urinary tract obstruction, concurrent esophageal atresia and gastrointestinal obstruction should also be considered.
