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P37Ileal atresia and thrombo‐embolic liver calcifications, a possible complication after treatment with intrauterine laser coagulation therapy for twin to twin transfusion syndrome
Author(s) -
Van ZalenSprock R. M.,
Schaap A. H. P.,
Van Wijngaarden W. J.,
Schnater J. M.,
Aronson D. C.,
Bleker O. P.
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00004-1-37.x
Subject(s) - medicine , laser coagulation , surgery , gestation , intestinal atresia , atresia , complication , autopsy , laparotomy , pregnancy , visual acuity , biology , genetics
Background Two fetuses with complications after laser coagulation therapy for twin to twin transfusion syndrome (TTTS) are described. Case 1 In this patient laser coagulation of the connecting placental vessels was performed at 21 weeks of gestation. Two weeks after this treatment the donor twin had died. Sonography of the survivor showed progressive intestinal distension from 24 weeks onwards. After birth a laparotomy was performed and an ileal atresia was found. Case 2 In this patient laser coagulation was performed at 19 weeks of gestation. Premature rupture of membranes occurred at 21 weeks and both fetuses died. At autopsy thrombo‐embolic calcifications were found in the liver of the smallest, donor twin. Discussion Whereas duodenum atresia is considered a ‘true’ congenital anomaly, jejuno/ileal atresia is thought to be caused by a mesenteric vascular accident during fetal life, which leads to necrosis. Intra‐uterine laser coagulation therapy seems promising in the treatment of TTTS. Although it cannot be proven, this therapy must be regarded as one of the possible causes for the thrombo‐embolic processes described in the two cases.