Pyloric perforation in utero in association with leukemoid reaction and hydrops fetalis

A 36-weeks dysmorphic newborn baby who presented with an antenatal diagnosis of intra-abdominal "cyst" and hydrops foetalis was proven to have a large cystic peritonitis. This was secondary to a large pyloroduodenal perforation, causing hemorrhagic ascites and abdominal wall and pedal edema. The peripheral blood picture was consistent with a myeloproliferative state. It was unclear whether the large perforation was secondary to necrotizing enteropathy seen in acute leukemia