中島 紗織, 松下 充, 神農 隆, 石井 桂介, 村越 毅, 成瀬 寛夫, 鳥居 裕一

Saori NAKAJIMA, Mitsuru MATSUSHITA, Takashi SHINNO, Keisuke ISHII, Takeshi MURAKOSHI, Hiroo NARUSE, Yuuichi TORII

聖隷浜松病院総合周産期母子医療センター産科

Division of Obstetrics and Perinatology,Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital

キーワード : intestinal atresia, meconium peritonitis, prenatal diagnosis, looped dilatation of fetal intestines, whirlpool sign

小腸閉鎖は胎児腹部超音波検査によって拡張した腸管が多発性の嚢胞として観察されることが多い．我々は胎児超音波検査にて，渦巻き状の形態でかつ腸管襞を伴う嚢胞を含む多発性の嚢胞を観察し，胎児腹水，腹腔内石灰化の経過を示した2症例を経験したので報告する．症例1は27歳，妊娠25週に胎児腸管のループ状の拡張像を指摘された．当院入院時には，腸管拡張像は高輝度の塊をループ状に取り囲む腸管襞を伴う多発性嚢胞として観察され，胎児腹水の貯留を認めた．妊娠37週には胎児腹水の消失，腸管拡張，高輝度腸管像，胎児腹腔内石灰化を認めたため小腸閉鎖，穿孔に続く胎便性腹膜炎を疑った．妊娠38週4日に帝王切開にて2,270gの男児を娩出した．出生後，児は小腸捻転，小腸閉鎖，胎便性腹膜炎と診断された．症例2は30歳，妊娠29週時に胎児腹腔内に渦巻き状の腸管拡張像と胎児腹水を認めた．妊娠36週には胎児腹水の消失，腸管拡張，高輝度腸管像，胎児腹腔内石灰化を認めたため小腸閉鎖，穿孔に続く胎便性腹膜炎を疑った．妊娠38週6日に2,958gの女児を経膣分娩した．出生後，児は小腸閉鎖，胎便性腹膜炎と診断された．胎児超音波検査において，渦巻き状に拡張した腸管を認めた場合には，胎児小腸閉鎖，腸穿孔に続き胎便性腹膜炎を呈する可能性を考慮に入れ，胎児超音波所見の変化に注意し慎重に観察する必要がある．

Fetal intestinal atresia (IA) presents as multiple dilated bowel loops. We report two cases of IA that presented as multiple swirling cysts and dilated bowel loops followed by fetal ascites and calcification in the abdomen on prenatal sonography. A 27-year-old woman presented with fetal dilated bowel loops at 25 gestational weeks. Sonography revealed a dilated bowel loop around a highly echogenic area along with multiple cysts and fetal ascites. Because prenatal ultrasonography at 37 weeks showed a highly echogenic small intestine, calcification in the abdomen, and no fetal ascites, fetal meconium peritonitis after intestinal perforation was suspected. At 38.4 weeks, a male infant weighing 2,270 g was delivered by caesarian section. A 30-year-old woman presented with fetal dilated, swirling bowel loops and fetal ascites at 29 gestational weeks. Because prenatal ultrasonography at 36 weeks showed dilated bowel loops, a highly echogenic small intestine, calcification, and no fetal ascites, fetal meconium peritonitis after intestinal perforation was suspected. At 38.6 weeks, a female infant weighing 2,958 g was delivered transvaginaly. In both the cases, IA and meconium peritonitis were confirmed at laparotomy. If looped dilatation of fetal intestines is suspected from fetal ultrasonography findings, changes in ultrasonographic findings that indicate IA, intestinal perforation, and meconium peritonitis should be anticipated.