Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Perinatal/Neonatal Case Presentation

Ascites, anemia and (intestinal) atresia

Abstract

We report a neonate who presented antenatally with fetal ascites and fetal anemia. The cause of this remained uncertain until 2 weeks later when bowel dilatation was noted on antenatal ultrasound. Clinical signs of intestinal obstruction became evident after delivery, and ileal atresia was found at laparotomy, which was resected with primary anastomosis. Recent reports in the literature have suggested a possible connection between fetal ascites, anemia and dilated bowel with neonatal intestinal obstruction. In these cases and ours, the likely sequence of events was that of in utero midgut volvulus with bleeding into ischemic bowel, hemorrhagic ascites resulting in fetal anemia and progressive bowel dilatation occurring as a consequence of intestinal atresia. Early treatment in our patient with intrauterine blood transfusion may have altered the natural history of her condition, allowing pregnancy to progress to term with a subsequent improved outcome.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2
Figure 3

References

  1. Zelop C, Benacerraf BR . The causes and natural history of fetal ascites. Prenat Diagn 1994; 14 (10): 941–946.

    CAS  Article  Google Scholar 

  2. Papantoniou N, Sifakis S, Antsaklis A . Therapeutic management of fetal anemia: review of standard practice and alternative treatment options. J Perinat Med 2013; 41: 71–82.

    Article  Google Scholar 

  3. Lakhoo K . Fetal counselling for surgical conditions. Earl Hum Dev 2012; 88: 9–13.

    Article  Google Scholar 

  4. Noreldeen SA, Hodgett SG, Venkat-Raman N . Midgut volvulus with hemorrhagic ascites: a rare cause of fetal anemia. Ultrasound Obstet Gynecol 2008; 31: 352–354.

    CAS  Article  Google Scholar 

  5. Steffensen TS, Gilbert-Barness EG, De Stefano KA, Kontopoulos EV . Midgut volvulus causing fetal demise in utero. Fetal Pediatr Pathol 2008; 27: 223–231.

    Article  Google Scholar 

  6. Kornacki J, Czarnecka M, Blaszczynski M, Skrzypczak J, Gadzinowski J, Jankowski A et al. Congenital midgut volvulus associated with fetal anemia. Fetal Diagn Ther 2010; 28: 119–122.

    Article  Google Scholar 

  7. Juang D, Snyder CL . Neonatal bowel obstruction. Surg Clin North Am 2012; 92 (3): 685–711.

    Article  Google Scholar 

  8. Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA . Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 1998; 133 (5): 490–496.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We thank Dr Dale Loh and Dr Vidyadhar Mali (Department of Pediatric Surgery, National University Hospital, Singapore) for helpful discussions.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C Amutha.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tan, R., Lee, J., Biswas, A. et al. Ascites, anemia and (intestinal) atresia. J Perinatol 34, 78–80 (2014). https://doi.org/10.1038/jp.2013.124

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.124

Keywords

  • fetal ascites
  • fetal anemia
  • fetal bowel dilatation
  • jejunoileal atresia
  • intestinal atresia

Search

Quick links