Fetal Echogenic Bowel on Ultrasound: Is There Clinical Significance?

Abstract

Though echogenic fetal bowel has been associated with meconium ileus and/or peritonitis, it may be a normal finding in the second trimester. The purpose of this study is to determine which characteristics might distinguish fetuses ultimately having abnormal outcomes in a population at low risk for cystic fibrosis. Seven fetuses with echogenic bowel were identified: 5 fetuses ≤ 20 weeks gestation (group 1) and 2 fetuses 20–25 weeks gestation (group 2) at diagnosis. Four of 5 group 1 fetuses had resolution of the echogenic bowel during the second trimester. One group 2 fetus had a persistent mass associated with growth deficiency and trisomy 18. The neonatal bowel evaluation was normal in the remaining 2 fetuses although echogenic findings persisted into the third trimester. In a low-risk population, echogenic bowel usually resolves without neonatal sequelae. Even when persistent into the third trimester, echogenic bowel does not uniformly herald an abnormal outcome. Echogenic bowel coexistent with other abnormalities (such as growth deficiency or structural malformations) may be a comarker for aneuploidy.

Prenatal ultrasound findings in affected and unaffected pregnancies that are screen-positive for trisomy 18: the California experience

“…Beginning in the late 1980s, numerous reports review the prenatal ®ndings associated with trisomy 18 (Warner and Roth, 1986;Benacerraf, 1989;Dicke and Crane, 1991;Nicolaides et al, 1992a,b;Nyberg et al, 1993;Kurjak et al, 1999). Some of these ®ndings include: intrauterine growth retardation (IUGR) (Salihu et al, 1997;Nyberg et al, 1993;Twining et al, 1993); abnormal growth, as measured by the biparietal diameter and femur length ratio (Benattar et al, 1999); Seoud et al, 1994;Dicke and Crane, 1991;(Ginsberg et al, 1990); choroid plexus cysts (Reinsch, 1997;Donnenfeld, 1995;Nadel et al, 1992;Platt et al, 1991;Fitzsimmons et al, 1989;Ostlere et al, 1989;Chitkara et al, 1988); abnormal positioning of ®ngers and clenched hand (Quintero et al, 1999); cardiac abnormalities (Gembruch et al, 1997;Paladini et al, 1993;Wladimiroff et al, 1989); echogenic bowel (Sipes et al, 1994;Scioscia et al, 1992); and facial and head abnormalities (Nicolaides et al, 1992a(Nicolaides et al, ,b,1993Benacerraf et al, 1986). Other unusual ®ndings with more uncertain implications include cystic hygroma (Shields et al, 1998); nuchal thickening (Nyberg et al, 1993); single umbilical artery (Sener et al, 1997); and polyhydramnios (Sickler et al, 1997).…”

Sonographic markers of fetal trisomies: second trimester.

“…8). [74][75][76][77][78] Hyperechoic bowel has also been reported in association with bowel atresia, congenital infection, and, rarely, meconium ileus secondary to cystic fibrosis. 79,80 An increased risk of IUGR, fetal death, and placenta-related complications is also recognized as being associated with hyperechoic bowel.…”

Prospective ranking of the sonographic markers for aneuploidy: Data of 2143 prenatal cytogenetic diagnoses referred for abnormalities on ultrasound

“…There are numerous patterns of association of ultrasound anomalies in fetuses with or without aneuploidy. Many studies focus on describing the karyotypic findings with a single anomaly, for example holoprosencephaly, 1 cystic hygroma, 2 exomphalos, 3 duodenal atresia, 4 cardiac anomalies, 5 choroid plexus cysts, 6 micrognathia, 7 nuchal thickening, 8–10 relative shortness of the femur, 11 echogenic bowel, 12 and single umbilical artery 13 . Other studies and reviews report the sonographic anomalies in routine second trimester ultrasound screening 14 or in groups of known aneuploid fetuses 15–20 .…”