Diagnostic Evaluation of Neonatal Ascites

ABSTRACT

We present the case of a premature infant noted to have massive abdominal distension at birth. Obstetric ultrasound at delivery was significant for abdominal distension, oligohydramnios, and restricted chest wall motion. He was diagnosed to have posterior urethral valves with intraperitoneal rupture of the bladder. We present this case with a brief review of the literature.

KEYWORDS

Urinary ascites - chylous ascites - biliary ascites - neonatal abdominal distension - posterior urethral valves - paracentesis

REFERENCES

• 1 Agrawala G, Predanic M, Perni S C, Chasen S T. Isolated fetal ascites caused by bowel perforation due to colonic atresia.  J Matern Fetal Neonatal Med. 2005;  17(4) 291-294
• 2 Chen F P, Teng L F, Lee N. Spontaneous resolution of severe fetal ascites in the second trimester: a case report.  J Reprod Med. 2007;  52(3) 253-255
• 3 Haller J O, Condon V R, Berdon W E et al.. Spontaneous perforation of the common bile duct in children.  Radiology. 1989;  172(3) 621-624
• 4 Saltzman D A, Snyder C L, Leonard A. Spontaneous perforation of the extrahepatic biliary tree in infancy. A case report.  Clin Pediatr (Phila). 1990;  29(6) 322-324
• 5 So S K, Lindahl J A, Sharp H L et al.. Bile ascites during infancy: diagnosis using disofenin Tc 99m sequential scintiphotography.  Pediatrics. 1983;  71(3) 402-405
• 6 Lee C M, Stewart L, Way L W. Postcholecystectomy abdominal bile collections.  Arch Surg. 2000;  135(5) 538-542 discussion 542-4
• 7 Ahmed S, Borghol M, Hugosson C. Urinoma and urinary ascites secondary to calyceal perforation in neonatal posterior urethral valves.  Br J Urol. 1997;  79(6) 991-992
• 8 Sie A H, Patel N, Spenceley N. Neonatal urinary ascites in renal candidal infection.  J Paediatr Child Health. 2006;  42(6) 387-388
• 9 Stein R J, Noh P H, Wu H Y. Urinary ascites without hydronephrosis in a neonate with urethral atresia.  Urology. 2005;  66(2) 432
• 10 Mann C M, Leape L L, Holder T M. Neonatal urinary ascites: a report of 2 cases of unusual etiology and a review of the literature.  J Urol. 1974;  111(1) 124-128
• 11 Soman A, Thayyil S, Ogilvy-Stuart A et al.. Fetal ascites secondary to urinary hydrocolpos.  J Perinat Med. 2006;  34(4) 347-348
• 12 Scott T W. Urinary ascites secondary to posterior urethral valves.  J Urol. 1976;  116(1) 87-91
• 13 Kelalis P P, King L R, Belman A B. Infravesical obstruction. In: Kaplan GW Clinical Pediatric Urology. Philadelphia; WB Saunders 1992: 835-836
• 14 Adams M C, Ludlow J, Brock III J W, Rink R C. Prenatal urinary ascites and persistent cloaca: risk factors for poor drainage of urine or meconium.  J Urol. 1998;  160(6 Pt 1) 2179-2181
• 15 Shono T, Taguchi T, Suita S, Nakanami N, Nakano H. Prenatal ultrasonographic and magnetic resonance imaging findings of congenital cloacal anomalies associated with meconium peritonitis.  J Pediatr Surg. 2007;  42(4) 681-684
• 16 Clarke Jr H S, Mills M E, Parres J A, Kropp K A. The hyponatremia of neonatal urinary ascites: clinical observations, experimental confirmation and proposed mechanism.  J Urol. 1993;  150(2 Pt 2) 778-781
• 17 Sullivan M J, Lackner L H, Banowsky L H. Intraperitoneal extravasation of urine, BUN/serum creatinine disproportion.  JAMA. 1972;  221 491-492
• 18 Walsh P C, Retik A B, Stamey T A, Vaughan Jr E D. The pathophysiology of urinary tract obstruction. In: Gillenwater JY Campbell's Urology. Philadelphia; WB Saunders 1992: 524-525
• 19 Fleisher D S, Gribetz B. Autodialysis in neonatal urinary ascites.  Clin Pediatr (Phila). 1985;  24 724-726
• 20 Clarke H S, Mills M E, Parres J A, Kropp K A. The hyponatremia of neonatal urinary ascites: clinical observations, experimental confirmation and proposed mechanism.  J Urol. 1993;  150 778-781
• 21 Kay R, Brereton R J, Johnston J H. Urinary ascites in the newborn.  Br J Urol. 1980;  52 451-454
• 22 Kleppe S, Schmitt J, Geipel A et al.. Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function.  J Perinat Med. 2006;  34(5) 425-428
• 23 Tank E S, Carey T C, Seifert A L. Management of neonatal urinary ascites.  Urology. 1980;  16(3) 270-273
• 24 Beshay V E, Beshay J E, Rosenberg A J. Chylous ascites: a case of child abuse and an overview of a rare condition.  J Pediatr Gastroenterol Nutr. 2001;  32(4) 487-489
• 25 Lloyd D A. Gastroschisis, malrotation, and chylous ascites.  J Pediatr Surg. 1991;  26(1) 106-107
• 26 Chye J K, Lim C T, Van der Heuvel M. Neonatal chylous ascites-report of three cases and review of the literature.  Pediatr Surg Int. 1997;  12(4) 296-298
• 27 Olazagasti J C, Fitzgerald J F, White S J, Chong S K. Chylous ascites: a sign of unsuspected child abuse.  Pediatrics. 1994;  94(5) 737-739
• 28 Bhatia C, Pratap U, Slavik Z. Octreotide therapy: a new horizon in treatment of iatrogenic chyloperitoneum.  Arch Dis Child. 2001;  85(3) 234-235
• 29 Andreou A, Papouli M, Papavasiliou V, Badouraki M. Postoperative chylous ascites in a neonate treated successfully with octreotide: bile sludge and cholestasis.  Am J Perinatol. 2005;  22(8) 401-404
• 30 Mitsunaga T, Yoshida H, Iwai J et al.. Successful surgical treatment of two cases of congenital chylous ascites.  J Pediatr Surg. 2001;  36(11) 1717-1719
• 31 Vasko J S, Tapper R I. The surgical significance of chylous ascites.  Arch Surg. 1967;  95(3) 355-368
• 32 Sooriakumaran P, McAndrew H F, Kiely E M et al.. Peritoneovenous shunting is an effective treatment for intractable ascites.  Postgrad Med J. 2005;  81(954) 259-261
• 33 Coley B D, Seguin J, Cordero L et al.. Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters.  Pediatr Radiol. 1998;  28(12) 923-927
• 34 Panetta J, Morley C, Betheras R. Ascites in a premature baby due to parenteral nutrition from an umbilical venous catheter.  J Paediatr Child Health. 2000;  36(2) 197-198
• 35 Runyon B A, Montano A A, Akriviadis E A et al.. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites.  Ann Intern Med. 1992;  117(3) 215-220
• 36 Torres E, Barros P, Calmet F. Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension.  Am J Gastroenterol. 1998;  93(11) 2172-2178
• 37 Runyon B A. Bacterial infections in patients with cirrhosis.  J Hepatol. 1993;  18(3) 271-272
• 38 Runyon B A. Cardiac ascites: a characterization.  J Clin Gastroenterol. 1988;  10(4) 410-412
• 39 Demir K, Okten A, Kaymakoglu S et al.. Tuberculous peritonitis-reports of 26 cases, detailing diagnostic and therapeutic problems.  Eur J Gastroenterol Hepatol. 2001;  13(5) 581-585
• 40 D'Cruz A J, Kamath P S, Ramachandra C, Jalihal A. Pancreatic ascites in children.  Acta Paediatr Jpn. 1995;  37(5) 630-633
• 41 Runyon B A. Amylase levels in ascitic fluid.  J Clin Gastroenterol. 1987;  9(2) 172-174