Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

Calcified intraluminal meconium on prenatal ultrasound (figure 1). Confirmed after delivery with calcifications in region of a redundant sigmoid colon (arrow, figure 2). The baby underwent diverting colostomy. There was difficulty in catheterizing him, and so a suprapubic tube was placed. A voiding cystourethrogram was done through the suprapubic tube and showed reflux into a long utricle (u), and reflux through the rectourethral communication into the blind-ending rectum (r) and then out through the distal limb of the colostomy (figure 3). The urethra was otherwise normal.

When urine and meconium mix in the lumen of the bowel of the fetus, the meconium often calcifies. Therefore, when one sees calcified intraluminal meconium, either in utero of after delivery, the usual diagnosis in a boy is high imperforate anus, and in a girl, the cloacal malformation.