Isolated fetal megacystis: A case report

Fetal megacystis is an abnormally enlarged bladder appearing after 10 weeks of gestational age (GA), when the fetus starts to produce urine. The bladder forms one of the most readily identified structures in the fetus. Abdominal ultrasound is able to assess the bladder during gestation weeks 11-14 in 90% of cases. In the first trimester of gestation megacystis occurs in 1 in 1831 pregnancies and it is defined by a longitudinal bladder diameter of 7 mm or more and/or greater than 10% of the crown-rump length. Isolated congenital megacystis represents a rare variant of fetal megacystis without other associated anomalies. The aetiology is unclear, and various management strategies have been proposed. However, the presence of megacystis should alert the physician to the possibility of chronic intestinal pseudoobstruction syndrome. We present the case of a 37 year-old (gravida 1 para 0), XIII weeks pregnant, healthy woman that is referred to our institution for the first quarter ultrasound evaluation. The prenatal ultrasound demonstrates a single male fetus presenting with an anechoic cyst that it occupies the middle and the left side of the abdomen and it is likely attributed to the bladder. The patient is recommended to perform a specialized consultancy at the Policlinico "Gemelli" in Rome where you can find the possibility to intervene, in cases like that of our patient, with vesicoamniotic shunt that facilitates the passage of urines from the bladder to the amniotic cavity. After the specialized consultancy, however, the patient decides to terminate the pregnancy and at the XXIII week of gestation, the patient was admitted at the "Santo Bambino" hospital for termination of pregnancy (because of fetal disease).