What is the diagnosis for a 37-year-old woman, gravida (number of times pregnant) 2, para (number of viable births) 1, at 22 weeks gestation, with a fetal ultrasound showing a dilated, fluid-filled stomach and proximal intestinal segment?

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Differential Diagnosis for Fetal Ultrasound Findings

  • Single most likely diagnosis
    • Duodenal atresia: This condition is characterized by a complete obstruction of the duodenum, which would explain the dilated fluid-filled stomach and proximal intestinal segment seen on the ultrasound. The absence of intraluminal air or fluid in the remainder of the bowel supports this diagnosis, as it suggests that the obstruction is preventing the normal passage of intestinal contents.
  • Other Likely diagnoses
    • Duodenal stenosis: Similar to duodenal atresia, duodenal stenosis is a narrowing of the duodenum that can cause obstruction and lead to the accumulation of fluid in the stomach and proximal intestine.
    • Intestinal obstruction (e.g., due to volvulus or intussusception): Although less common, other types of intestinal obstruction could also cause the observed ultrasound findings.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Esophageal atresia with tracheoesophageal fistula: This condition can cause polyhydramnios (excess amniotic fluid) and may be associated with other congenital anomalies. Although the primary finding is esophageal, it can sometimes present with gastric dilation.
    • Congenital diaphragmatic hernia: This condition can cause bowel to herniate into the thoracic cavity, potentially leading to intestinal obstruction and the observed ultrasound findings.
  • Rare diagnoses
    • Jejunal atresia: This condition is less common than duodenal atresia and involves an obstruction of the jejunum, which could potentially cause similar ultrasound findings.
    • Congenital megacalculus: A rare condition where there is a large calcification in the intestinal wall, potentially causing obstruction. However, this would more likely present with calcifications visible on the ultrasound rather than just dilation.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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