Fetal ascites in cloacal malformations—a red flag
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In brief
In brief
This case series identifies fetal ascites as a critical prenatal warning sign in cloacal malformations, correlating with extensive bowel adhesions that complicate initial surgical repair. The study emphasizes the need for experienced surgical teams and anticipation of hemodynamic instability when ascites is detected antenatally in these rare congenital anomalies.
Written by the GCMD Library team from the article.
Abstract
Introduction
Cloacal malformation is a rare anomaly that remains a diagnostic challenge prenatally, despite the current advances in ultrasonography and MRI. This condition can in some, present with isolated ascites or with other findings, such as a pelvic cyst or upper urinary tract dilatation. In a minority, the ascites may be progressive, questioning the role of antenatal intervention.
Methods
We report on ten patients that have been identified from our Cloaca database between 2010 and 2022.
Results
The presence of ascites was associated with extensive bowel adhesions and matting, leading to a challenging initial laparotomy and peri-operative course.
Conclusions
Antenatal finding of ascites in newborns with cloacal malformations should raise a red flag. The surgeon and anaesthetist should be prepared for the operative difficulties secondary to bowel adhesions and the higher risk of haemodynamic instability at the initial surgery. An experienced team at initial laparotomy in such patients is vital.
Level of evidence: II.