March 23rd, 2018

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Fetal Ascites with Jejunal Atresia and Apple Peel Deformity: A Case Report
Authors:  Alexandra Wilson, M.S., and Richard P. Porreco, M.D.
BACKGROUND: Fetal ascites can be a challenging diagnostic finding on antenatal ultrasound. A thorough evaluation including amniocentesis, detailed fetal ultrasound, and genetic testing is indicated to determine whether the ascites represents part of a systemic disorder or whether it is an isolated finding.

CASE: We report a neonate who initially presented with massive fetal ascites starting at 16 weeks’ gestation. A total of 3,321 cc of ascitic fluid was serially removed from the fetus before delivery at 35 weeks’ gestation. After delivery the neonate was found to have jejunal atresia with apple peel deformity, which was repaired via end-to-end anastomosis shortly after birth.

CONCLUSION: Concomitant congenital small bowel atresia and apple peel deformity is rare, and this case uniquely reports this lesion associated with the fetal onset of massive ascites without polyhydramnios.
Keywords:  apple peel small bowel syndrome; apple peel syndrome; apple-peel intestinal atresia; atresia, intestinal; congenital intestinal atresia; familial apple peel jejunal atresia; jejunal atresia; apple-peel deformity; fetal ascites; fetal paracentesis; intestinal atresia; jejunal atresia; Stromme syndrome
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