Association between fetal echogenic and/or dilated bowel and adverse perinatal outcomes

Echogenic and/or dilated bowel is uncommonly encountered on prenatal ultrasound and may represent either a panel of differential diagnoses or a transient normal variant with excellent outcome. Prenatal differentiation between the two entities remains uncertain. Here, we aimed to review prenatal cases associated with echogenic and/or dilated bowel and analyze their prospective perinatal outcomes.

This was a retrospective cohort study, carried out at a single center. All relevant data was retrieved from the hospital electronic records. Bowel echogenicity is defined as grade 0-3, in relation to the surrounding liver or bone echogenicity. Bowel dilatation is defined as the largest diameter >7 mm with the length >15 mm.

Out of 59 cases with prenatal echogenic and or dilated bowel, 32 cases were analyzed, and 10/32 (31%) neonates among all categories showed intestine related pathologies that required postnatal care. Two out of 19 (11%) cases with echogenic bowel and one out of three (34%) cases with bowel dilatation revealed structural abnormality that required postnatal surgery. All cases were in stable conditions upon discharge from the hospital. There were no cases of perinatal death associated with bowel abnormalities.

Echogenic bowel in isolation carries a low risk for structural bowel anomalies that require surgery. Dilated bowel represents an increased risk for intestinal obstruction. Combination of two ultrasonographic features, echogenicity and dilatation of the intestine should be considered as a suspicious sign of a genetic syndrome which may alter bowel function but may not require surgery.