The esophageal 'pouch sign': a benign transient finding

Area of Science:

• Perinatology
• Fetal Medicine
• Pediatric Surgery

Background:

• The sonographic detection of an esophageal pouch in utero has historically been considered pathognomonic for fetal esophageal atresia (EA).
• This diagnostic assumption can lead to significant clinical uncertainty and potentially impact pregnancy management decisions.

Purpose of the Study:

• To investigate the clinical significance of the sonographic finding of a fetal esophageal pouch.
• To determine if this finding is truly indicative of esophageal atresia or if it can occur in structurally normal fetuses.

Main Methods:

• Longitudinal sonographic monitoring of six fetuses with esophageal neck pouches, polyhydramnios, and small or absent stomachs.
• Observation of fetal swallowing and pouch distension, with follow-up examinations every 2-3 weeks.
• Neonatal diagnostic work-up to confirm or exclude esophageal atresia.

Main Results:

• Esophageal pouches were first visualized between 18 and 29 weeks of gestation, consistently located above the fetal clavicle.
• No additional fetal anomalies or chromosomal abnormalities were detected in the studied cohort.
• Polyhydramnios resolved, and stomach size normalized between 21 and 33 weeks gestation.
• Neonatal evaluations definitively ruled out esophageal atresia in all six cases.

Conclusions:

• The sonographic "esophageal pouch sign" can be observed in structurally normal fetuses.
• This finding is not pathognomonic for fetal esophageal atresia (EA).
• The presence of a fetal esophageal pouch should not be a basis for pregnancy termination.