Skip to main content
Log in

Fetal stomach paracentesis in combined duodenal and esophageal atresia

  • Case Report
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Fetuses with concomitant duodenal atresia (DA) and esophageal atresia (EA) might develop in utero gastric rupture as well as neonatal respiratory complication due to dilated stomach and duodenum. Our patient with the typical “double bubble” appearance was highly suspected to have DA in the second trimester. Follow-up examinations revealed a massively dilated stomach and duodenum with a dilated distal esophagus, indicating concomitant DA and EA. With advancing pregnancy, the fetal abdomen progressively increased in size by retention of fluid in the closed loop of DA and EA. To avoid gastric perforation, prenatal stomach paracentesis using an ultrasound-guided needle was performed three times until delivery. A male neonate born at 37 weeks gestation showed no respiratory complication. Perinatal clinical features and operative findings revealed combined DA and EA (gross type A). He was successfully managed with duodenoduodenostomy, followed by esophago-esophagostomy. On fetal sonography, the marked “double bubble” appearance and the cystic structure presenting peristalsis-like movement above the diaphragm were indicative of concomitant DA and EA. Fetal stomach paracentesis could contribute to the improvement of perinatal outcomes in fetuses with this pathological condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Estroff JA, Parad RB, Share JC, et al. Second trimester prenatal findings in duodenal and esophageal atresia without tracheoesophageal fistula. J Ultrasound Med. 1994;13:375–9.

    CAS  PubMed  Google Scholar 

  2. Marquette GP, Skoll MA, Yong SL, et al. First-trimester imaging of combined esophageal and duodenal atresia without a tracheoesophageal fistula. J Ultrasound Med. 2004;23:1232.

    PubMed  Google Scholar 

  3. Pameijer CR, Hubbard AM, Coleman B, et al. Combined pure esophageal atresia, duodenal atresia, biliary atresia, and pancreatic ductal atresia: prenatal diagnostic features and review of the literature. J Pediatr Surg. 2000;35:745–7.

    Article  CAS  PubMed  Google Scholar 

  4. Mitani Y, Hasegawa T, Kubota A, et al. Prenatal findings of concomitant duodenal and esophageal atresia without tracheoesophageal fistula (gross type A). J Clin Ultrasound. 2009;37:403–5.

    Article  PubMed  Google Scholar 

  5. Hayden CK Jr, Schwartz MZ, Davis M, et al. Combined esophageal and duodenal atresia: sonographic findings. AJR Am J Roentgenol. 1983;140:225–6.

    Article  PubMed  Google Scholar 

  6. Kelly EJ, Brownlee KG. When is the fetus first capable of gastric acid, intrinsic factor and gastrin secretion? Biol Neonate. 1993;63:153–6.

    Article  CAS  PubMed  Google Scholar 

  7. Miclat NN, Hodgkinson R, Marx GF. Neonatal gastric pH. Anesth Analg. 1978;57:98–101.

    Article  CAS  PubMed  Google Scholar 

  8. Koldovsky O, Berseth CL. Digestion-absorption functions in fetuses, infants, and children. In: Polin RA, Fox WW, Abman SH, editors. Fetal and neonatal physiology. 4th ed. Philadelphia: Saunders; 2011. p. 1151–62.

    Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest related to the submission of this manuscript.

Ethical standards

The study was performed in accordance with the Declaration of Helsinki, and informed consent was obtained from the woman where appropriate.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kei Miyakoshi.

About this article

Cite this article

Kadohira, I., Miyakoshi, K., Shimojima, N. et al. Fetal stomach paracentesis in combined duodenal and esophageal atresia. J Med Ultrasonics 41, 397–400 (2014). https://doi.org/10.1007/s10396-014-0518-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-014-0518-z

Keywords

Navigation