Echogenic bowel on the second-trimester ultrasound as an indicator of jejunal atresia: a case report

Fetal echogenic bowel (FEB) is a finding on prenatal ultrasound characterized by increased echogenicity of the fetal intestine. In this study we present a case of FEB with severe bowel dilatation identified on second-trimester ultrasound that was subsequently diagnosed with jejunal atresia postnatally.

A 28-year-old primigravida woman was referred to our perinatology clinic at 18 weeks/3 days gestational age for a fetal anomaly scan. The anomaly scan examination identified grade 3 fetal bowel hyperechogenicity. The results of the fetal echocardiogram and maternal serum screening for TORCH infections were normal, and the NIPT analysis showed low-risk results for chromosomal aneuploidies.

In our case, the fetal bowel diameter measured 21 mm at 29 weeks/6 days gestational age, which significantly exceeded the established clinical cut-off value for fetal bowel dilatation. This timing is crucial because if a specific problem is detected in the ultrasound that indicates an abortion of the fetus, it can only be performed legally under the 19th week of pregnancy; otherwise, termination of pregnancy is considered illegal according to the policies of this country.

Nowadays, ultrasonography is a non-invasive tool that facilitates the early detection of many prenatal problems. In this case, with the early detection of FEB and further investigations, we were able to safely manage the pregnancy until the 39th week of pregnancy and plan the delivery in a tertiary referral center to ensure the availability of intensive care for the baby at birth.