Vesical calculus: an unusual cause of labour dystocia.

Case report A 36-year-old primigravida was referred to our centre at 22 weeks ’ gestation for routine morphological ultrasound examination. During this scan, focal hyperechogenic findings were detected in the bowel, heart and liver surface (Figure 1). The patient was then closely monitored with serial ultrasound examinations that showed dilated ileal bowel loops with peristalsis present. Maternal virus investigations were negative; she was negative for cystic fibrosis (CFTR gene investigated by oligonucleotide ligation assay for most frequent mutations in our population) and the amniocentesis showed a normal fetal karyotype. The induction of lung maturity was performed, with betamethasone (12 mg/day for 2 days), at 33 weeks, for increasing enlargement of the intestinal loops. Lung maturity was then checked by amniocentesis for L/S ratio and phosphatidylglycerol presence and delivery by caesarean section occurred at 35 weeks. At birth, the infant showed a good adaptation to extrauterine life (weight: 3.160 kg; Apgar scores: 9 at 1 min and 10 at 5 min). In the first hours of life, progressive further abdominal distension was shown. After radiological evaluation, the child was subjected to exploratory laparotomy on the 2nd day of life, which showed a jejunal atresia type IV and double ileal atresia type I (Shorter et al. 2006) and the atresia was recanalised. The baby was discharged on the 31st day with a follow-up programme in place. The child is 3 years old at the time of writing and is in good health.