Dilated and Echogenic Fetal Bowel and Postnatal Outcomes: A Surgical Perspective. Case Series and Literature Review

Abstract

Introduction: Foetal dilated or echogenic bowel have been described as markers for a variety of conditions including bowel obstruction, chromosomal and infectious disorders and cystic fibrosis. We aim to describe possible surgical interventions and outcomes.

Methods: A 5-year review was performed of the clinical course of infants with antenatally diagnosed isolated echogenic bowel and/or dilated bowel or intraabdominal echogenic foci presenting at Princess Margaret Hospital for Children, Perth, Western Australia.

Results: Abnormal antenatal findings were present in 35 foetuses. Twelve babies underwent surgery for intestinal atresia, meconium ileus and duplication cysts. Postoperative courses and outcomes were good.

Conclusions: Echogenic bowel on antenatal ultrasound is a non-specific marker for a variety of disorders. Although associated with higher rates of foetal loss, the majority of neonates are normal at delivery. Bowel dilatation with or without echogenicity is often predictive of bowel obstruction requiring surgery. Surgical outcomes are, however, very good. Echogenic foci elsewhere in the abdomen have little postnatal significance.

dilated bowel - echogenic bowel - antenatal ultrasound

References

• 1 Phelps S, Fisher R, Partington A. et al . Prenatal ultrasound of gastrointestinal malformations.  J Pediatr Surg. 1997;  32 438-440
• 2 Berlin BM, Norton ME, Sugarman EA. et al . Cystic fibrosis and chromosome abnormalities associated with echogenic fetal bowel.  Obstet Gynecol. 1999;  94 135-138
• 3 Bromley B, Doubilet P, Frigoletto FD. et al . Is fetal hyperechoic bowel on second-trimester sonogram an indication for amniocentesis?.  Obstet Gynecol. 1994;  83 647-651
• 4 MacGregor SN, Tamura R, Sabbagha R. et al . Isolated hyperechoic fetal bowel: significance and implications for management.  Am J Obstet Gynecol. 1995;  173 1254-1258
• 5 Shawis R, Antao B. Prenatal bowel dilatation and the subsequent postnatal management.  Early Hum Dev. 2006;  82 297-303
• 6 Sepulveda W, Sebire NJ. Fetal echogenic bowel: a complex scenario.  Ultrasound Obstet Gynecol. 2000;  16 510-514
• 7 Borsellino A, Zaccara A, Nahom A. et al . False-positive rate in prenatal diagnosis of surgical anomalies.  J Pediatr Surg. 2006;  41 826-829
• 8 Corteville JE, Gray DL, Langer JC. Bowel abnormalities in the fetus – Correlation of prenatal ultrasonographic findings with outcome.  Am J Obstet Gynecol. 1996;  175 724-729
• 9 Dicke JM, Crane JP. Sonographically detected hyperechoic fetal bowel: significance and implications for pregnancy management.  Obstet Gynecol. 1992;  80 778-782
• 10 Al Kouatly HB, Chasen ST, Streltzoff J. et al . The clinical significance of fetal echogenic bowel.  Am J Obstet Gynecol. 2001;  185 1035-1038
• 11 Yaron Y, Hassan S, Geva E. et al . Evaluation of fetal echogenic bowel in the second trimester.  Fetal Diagn and Ther. 1999;  14 176-180
• 12 Grignon A, Dubois J, Ouellet M. et al . Echogenic dilated bowel loops before 21 weeks’ gestation: a new entity.  AJR. 1997;  168 833-837
• 13 Zangheri G, Andreani M, Ciriella E. et al . Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery.  Prenat Diagn. 2007;  27 960-963
• 14 Muller F, Dommergues M, Aubry MC. et al . Fetus-placenta-newborn Hyperechogenic fetal bowel: an ultrasonographic marker for adverse fetal and neonatal outcome.  Am J Obstet Gynecol. 1995;  173 508-513
• 15 Carcopino X, Chaumoitre K, Shojai R. et al . Foetal magnetic resonance imaging and echogenic bowel.  Prenat Diagn. 2007;  27 272-278

Correspondence