Two cases of fetuses with urointestinal fistula

Introduction: Congenital urointestinal fistula is a rare abnormality. In a period of 8 years two male fetuses were referred to our centre because of dilated bowels with intraluminal echogenic foci combined with oligohydramnios. Suggested prenatal diagnosis, management and outcome diverged.

Case 1: In 2007 a 37-year-old second gravida was referred for ultrasound at 24 weeks of gestation. We found bowel dilatation with intraluminal fluid and enterolithiasis. Amniotic fluid was decreased. Fetal sphincter ani could be detected. We performed amniocentesis showing normal results. Further investigations showed increasing bowel dilatation and decreasing amniotic fluid. The suggested diagnosis was colon stenosis. At 34 weeks of gestation cesarian section was performed due to therapy resistant preterm labor. The birth weight was 2700 g. The newborn presented with respiratory problems and oliguria of unknown cause. On day three laparotomy was performed and a colostoma constructed because of high anal atresia. Furthermore intraoperative inspection showed rectovesicular fistula. In the postoperative course the boy was depressed and died the next day by sudden asystolia following surfactant application.

Case 2: In 2015 a 26-year-old first gravida was referred for ultrasound at 31 weeks of gestation. There were similar findings like in case 1 this time suggesting urointestinal fistula. In a prenatal interdisciplinary conference with pediatric surgeons an explorative laparotomy right after birth was planned. At 39 weeks of gestation the boy was delivered by cesarian section. The birth weight was 2930 g. Supralevatory anal atresia and rectovesicular fistula were confirmed. Postoperative course had no complications. 6 weeks after surgery the child is developing with no peculiarity.

Discussion: Because direct imaging by ultrasound is not possible, prenatal diagnosis of urointestinal fistula is difficult. Dilated fetal colon with echogenic foci caused by enterolithiasis combined with oligohydramnios serve as sufficient diagnostic signals. Early postnatal operation seems to be mandatory for positive outcome.