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Radiological Case of the Month

Thomas E. Sumner, MD; James E. Crowe, MD; Alan Klein, MD; Louis de S. Shaffner, MD; Lewis H. Nelson, MD; Martin I. Resnick, MD; Richard L. Weaver, MD; Lionel W. Young, MD
Am J Dis Child. 1981;135(1):67-68. doi:10.1001/archpedi.1981.02130250055016.
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A 3,692-g full-term infant girl was admitted to the hospital with abdominal distention and bilious vomiting. Prenatal maternal sonography for evaluation of an abnormally large uterus had showed polyhydramnios; fetal sonography had revealed a cystic abdominal mass. Physical examination showed a tachypneic infant with a small omphalocele and massive abdominal distention. Combined chest and abdominal roentgenograms were obtained, and they showed a distended, relatively gasless abdomen. Abdominal sonography (Fig 1), cystography (Fig 2), and a contrast-medium enema (Fig 3) preceded exploratory laparotomy.

Denouement and Discussion 

Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome  Abdominal sonography indicated that the cystic abdominal mass was a huge bladder; cystography confirmed megacystis without evidence of vesicoureteral reflux or bladder outlet obstruction. Contrast-medium enema showed a displaced microcolon that did not empty spontaneously. Initial laparotomy for repair of the small omphalocele showed a nonobstructed thick-walled bladder, nonurinary ascites, and a foreshortened distal small bowel and microcolon without intestinal atresia. Due to postoperative bilious vomiting, contrast-medium examination


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