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Traumatic Prenatal Sigmoid Perforation Due to Amniocentesis

May 8, 2009
Posted by: , Filed in: Obstetric Ultrasound
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Traumatic prenatal sigmoid perforation due to amniocentesis is uncommon, but unfortunately can happen.

This article will present a recent case study involving a normal pregnancy that included typical prenatal testing.

A review of the maternal medical record revealed a history of amniocentesis, complicated by post procedure fetal anterior abdominal wall hematoma.

Case Report: A full term newborn male presents at birth with a distended, tender, bluish abdomen. Abdominal series showed a 7.5 x 5.5 cm air fluid collection in the right upper quadrant with a normal stomach, duodenal loop, and proximal small bowel.

A water-soluble contrast enema demonstrated leakage of contrast material from the right aspect of the sigmoid colon which opacified a fistulous tract in the right lateral portion of the peritoneal cavity, filling a cavity posterolateral to the air fluid collection noted on plain film. The colon was small, without intraluminal meconium proximal to the perforation site.

A preliminary diagnosis of cystic meconium peritonitis due to sigmoid perforation was made. At laparotomy, a 4 mm perforation in the sigmoid and 2 non-communicating meconium cysts were identified. A fistulous tract communicated with the posterior cyst. Work-up for Hirschsprung’s disease and cystic fibrosis was negative.

The authors suggest the sigmoid perforation was a complication of amniocentesis, and that the increased incidence of “spontaneous intestinal perforation,” that is, free air seen on initial KUB (plain frontal supine radiograph of the abdomen) may be related to increasing prenatal testing.

With advances in molecular biology, genetics and reproductive endocrinology, the use of prenatal diagnostic techniques, amniocentesis and chorionic villus sampling has sky rocketed. Amniocentesis is usually performed between the 15th and 17th week of gestation, using a 20 to 22 gauge spinal needle.

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Third trimester amniocentesis assesses fetal maturity. The site, determined by ultrasound, should have adequate amniotic fluid, and have no fetal parts or umbilical cord.

Maternal complications may include amniotic fluid leak, bleeding, preterm labor, and infection. Fetal injury may be caused by interruption of fetal maternal circulation or direct needle injury.

Skin injury is most common and can result in a scar, which may or may not be associated with internal injury.

Reported injuries due to amniocentesis include: laceration of viscera, pneumothorax, optic injury, hydrocephalus, porencephaly and arteriovenous fistulas in the extremities.

The authors stress that mid-gestational skin injuries may heal completely, thus absence of a scar does not exclude internal injuries due to an amniocentesis needle.

The authors attribute sigmoid perforation in this case to the amniocentesis needle. Other etiologies of obstruction with perforation including Hirschsprung’s disease and cystic fibrosis with meconium ileus were excluded, and the fetus developed an abdominal wall hematoma immediately post procedure.

This case illustrates the potential link between the recent increased incidence of “spontaneous perforations” in newborns and the increased frequency of amniocentesis.

Reviewer: Sosamma T. Methratta, M

Reference: Fines B, Ben-Ami TE, Yousefzadeh DK: Traumatic prenatal sigmoid perforation due to amniocentesis. Pediatric Radiology 2001; 31 (6) [June 2001]: 440-443


Related CME:
OB/GYN and Abdominal Sonography Update

University of California San Francisco, Department of Radiology
Read more or order: OB/GYN and Abdominal Sonography Update

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