Hamilton, New Zealand

This  is a 37-year-old multipara. A 19 week sonogram at another diagnostic centre was unremarkable. She presented at 26 weeks with massive antepartum hemorrhage. An ultrasound examination demonstrated

• A SGA fetus

• oligohydramnios

• distended rectum/large bowel

• highly echogenic bowel

• a small amount of ascites

• no right kidney.

The placenta was thick and dotted of echogenic spots:

The diagnostic impression was anorectal atresia +/- meconium peritonitis. The fetus was delivered two days later and an imperforate anus was confirmed (a small cutaneous fistula was noted). Further, some degree of lumbar spine dysraphism was also noted.

An anus was created. A follow-up renal examination demonstrate a hypertrophied left kidney (48mm) and a very small right kidney (25mm), round, and in an ectopic (right paraumbilical) location