A Case of fetal intestinal dilation and multiple enteroliths accompanied by oligohydramnios, presenting diagnostic challenges

Abstract

 This is a report of an unique urethral duplication with urethrorectal fistula in which fetal intestinal dilation and multiple foci of calcified intraluminal meconium were observed, accompanied by oligohydramnios, making fetal diagnosis difficult. The patient was a 28-year-old primigravida. During a routine antenatal check-up at 25 weeks of gestation, fetal ventricular septal defect and intrauterine growth restriction（－1.5SD）were noted. At 27 weeks, the amniotic fluid volume began to decrease, and we diagnosed oligohydramnios at 29 weeks. In addition, a dilated hyperechogenic bowel with ball-like echogenic structures were observed at the dorsal side of the fetal bladder. These findings suggested a fetal condition involving anorectal malformations, urethrorectal fistula, and lower urinary tract obstruction. Due to the presence of oligohydramnios, the patient was hospitalized from 35 weeks. At 36 weeks and 1 day, spontaneous rupture of membranes occurred, and an emergency cesarean section was performed due to breech presentation. During delivery, a large amount of intraluminal meconium calculi was expelled from the infant’s anus. No anorectal malformations ware observed, and urethral closure was confirmed. The infant was transferred to a specialized medical facility for surgical treatment at the second day of life. Further examination revealed a diagnosis of urethral duplication and urethrorectal fistula. A surgical procedure to separate the urethra and rectum is planned.