Transient Bowel Ischaemia of the Fetus

Abstract

Objective: To discover the different underlying conditions in 2 fetuses suffering from temporary bowel ischaemia. Methods: Abnormal bowel findings were detected using antenatal sonography. Results: The abnormal bowel findings disappeared postnatally. Transient ischaemia of the fetal bowel due to different causes has been advocated antenatally to explain the abnormal findings. When a normal blood supply to the bowel has been restored, either in utero or after birth, the abnormal findings disappear. Conclusions: Whenever gut dilatation is detected in a fetus at risk of bowel ischaemia the possibility of a transient functional finding must be considered.

Sonographic findings of transient marked proximal bowel dilatation in a growth-restricted fetus at 35 weeks’ gestation

“…Systematic review of the English literature (PubMed, Google Scholar, and Medline, 1966-2024) using the search terms “prenatal ultrasound,” “dilated fetal bowel,” “fetal growth restriction” and “impaired fetal growth,” confirm that prenatal sonographic findings of transient dilated proximal fetal bowel has been rarely noted in association with impaired fetal growth. We speculate that in our case, transient fetal bowel dysfunction with concurrent development of decreased amniotic fluid volume in a growth-restricted fetus may have reflected transient bowel ischemia as suggested by Ghi et al [16] . This would be similar to the well-established decrease in fetal renal arterial blood supply, decreased glomerular filtration rate (GFR), and decreased urine output resulting in oligohydramnios in association with growth-restricted fetuses, in an effort to conserve oxygen supply to essential organs (central nervous system, heart, and adrenals) [ 18 , 19 ].…”

“…In contrast, nonsurgical conditions including (but not limited to): cystic fibrosis-associated meconium ileus, congenital chloride diarrhea, microvillus inclusion disease, intestinal neuronal dysplasia, and meconium plug syndrome are well established and do not merit immediate surgical intervention [6] , [7] , [8] , [9] , [10] , [11] . Prenatal ultrasound findings of transient dilatation of loops of fetal bowel such as our case, have been reported infrequently [ 16 , 17 ].…”

“…Fetal bowel obstruction may be associated with aneuploidy (mostly Trisomy 21 in association with esophageal or duodenal atresia), and rarely select microduplications or deletions, with a detection rate in cases of low risk of aneuploidy of 3.85% by copy number variation sequencing (CNV-seq) in contrast to 7.69% by whole exome sequencing (WES) [12] , [13] , [14] , [15] . In addition, conditions associated with dilated loops of fetal bowel include a small subset of conditions in which this finding may be transient, which although prominent when seen, may dissipate with spontaneous resolution [ 16 , 17 ]. We present unusual sonographic findings associated with transient marked proximal fetal bowel dilatation with concurrent development of decreased amniotic fluid volume in a growth-restricted fetus at 35 and 3/7 weeks’ gestation.…”

Prenatal diagnosis of intestinal pseudo‐obstruction

“…The most common etiology is mechanical obstruction most frequently due to ileojejunal atresia or cystic fibrosis‐related meconium ileus. Functional, non‐obstructive, dilated small bowel with polyhydramnios has been described in congenital chloride diarrhea, a rare autosomal recessive trait3, in fetal paralytic ileus secondary to maternal benzodiazepam ingestion4 and, without polyhydramnios, as a manifestation of transient fetal bowel ischemia5. The diagnosis of CIPO has been suspected in the context of MMIHS6, 7.…”

Imagerie du tube digestif fœtal

“…Elle s'exprime par la distension segmentaire d'une anse (le plus souvent localisée dans le flanc droit de l'abdomen) et sa traduction postnatale est inconstante [17].…”