Figure 5: Sagital sections (8-12 weeks). The sinovaginal bulb progressively differentiates into the vagina.
Sherwood8 and his team have stated in a comprehensive pediatric statistical review that the incidence of abdominal tumors in newborns was approximately 0.2 percent. Longino et al4 seem to be of almost the same opinion. Their data suggest the following distribution of abdominal tumor type abnormalities:
58.9% kidneys and urinary tract
18.5% stomach, intestines, liver
12.8% genital tract
Miller et al6 have made a noteworthy remark when stating that disorders of urogenital origin have been increasing.
The most frequent differential diagnosis is the ovarian cyst. It exists in the lower abdomen, generally not in the midline, but laterally. It has a more circular than oval shape in form by ultrasound. Determination of the sex of the fetus can give an important aid to recognizing it. Other cystic formations, such as mesenteric cyst, and omental cyst, are very rare. Although they have no characteristic signs by ultrasound, it is necessary to keep them in mind.
Gynatresia may be of congenital origin or may be acquired. In the majority of cases, the first clinical symptoms of defects caused by vaginal atresia can be recognized during menarche. The stretch over the blockage enlarges significantly and causes tense lower abdominal cramp-like pain with occasional disorders of urination and/or defecation. Although our ultrasound results led us to suspect that the most likely cause was the narrowing of the urethral valve, this was excluded almost immediately after birth with participation of pediatric specialists. So our diagnosis was confirmed after the delivery only.
Intrauterine intervention (draining or shunting) can be necessary if the dilated uterus and vagina are causing a significant enlargement of the fetal kidneys. Otherwise, early postnatal therapy (surgical procedure) can be chosen.
We consider it to be worthy of attention that besides deformities of the urinary tract, a significant hydrocolpos may also be responsible for the fetal pyelectasia, as our case suggests. The case history of the newborn proves that pyelectasia has disappeared shortly after the retained matter was discharged.
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3. Heidenreich W: Genitale und extragenitale Fehbildungen beim Mayer- Rokitansky-Kuster-Syndrome. Dtsch Med Wochenschr 113:1092, 1988.
4. Longino LA, Martin LW: Abdominal masses in the newborn infant. Pediatrics 21:596, 1988.
5. Massafra C, Bartolozzi M, Bartolozzi P et al: Case report: Rokitansky-Kuster-Hauser syndrome with ectodactyly. Acta Obstet Gynec Scand 67:557, 1988.
6. Miller EI, Thomas RH: Fetal hydrocele detected in utero by ultrasound. Br J Radiol 52:620, 1979.
7. Neinstein LS, Castle G: Congenital absence of the vagina. Am J Dis Child 127:669, 1983.
8. Scherwood DW, Smith RC, Lemmon RH et al: Abnormalities of the genito-urinary tract discovered by palpation Pediatrics 18, 752, 1956.
9. Seidel G, Graber G: Generalized endometriosis. Zbl Gynecol 110:465, 1986.
10. Spence HM: Congenital hydrocolpos J Am Med Assoc 180:1100, 1962 11. Moore KL: The developing human. Clinically oriented embryology 3rd Ed. WB Saunders Co. Philadelphia, Pennsylvania 1982.