An unusual cause of neonatal ascites.

Espírito Santo R, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219882 Description A 30-year-old primigravida was referred to our institution due to an isolated fetal ascites (IFA). The gestation was uneventful until the 32nd week when the mother was hospitalised due to refractory hypertension. An ultrasound revealed a fetal abdominal circumference above percentile 99. Fetal parameters and amniotic fluid volume were normal. and The investigation of IFA was started on the mother: blood type was ARh+, indirect Coombs test and infectious serology (toxoplasmosis, syphilis, varicella-zoster, parvovirus B19, rubella, cytomegalovirus and herpes (TORCH)) were negative. A spontaneous vaginal delivery occurred at 34 weeks. As the ascites compromised ventilation, the neonate was intubated and an urgent paracentesis was performed evacuating 175 mL of a transudate, and thereafter, the caucasian female neonate with 2235 g was stable with spontaneous breathing. As the ascites persisted, the investigation continued on the neonate: blood group ARh+, negative direct Coombs test and normal echocardiography. Abdominal ultrasound showed dilated bowel loops. The abdominal X-ray revealed three hypertransparent images (figure 1), suggestive of a gastrointestinal anomaly. On the next day, there was a clinical (figure 2) and radiological worsening (figure 3). So an exploratory laparotomy was performed. A mesenteric defect, with intestinal malrotation and internal hernia was diagnosed. After surgery, she had a significant ponderal loss with a slow An unusual cause of neonatal ascites