ECHOGENIC DILATED BOWEL LOOPS BEFORE 21 WEEKS GESTATION - A NEW ENTITY

OBJECTIVE. The purpose of this study was to determine the outcome at b irth for fetuses in which echogenic dilated bowel loops (EDBL) are det ected before 21 weeks of gestation. MATERIALS AND METHODS. A retrospec tive study was undertaken of 45 patients with EDBL. Sonographic criter ia included dilated bowel with an echogenic wall. EDBL was divided int o two categories: the isolated and the complex (associated with other abnormalities), When the EDBL affected only one quadrant of the fetal abdomen, it was referred to as the local form, and when it was observe d in more than one quadrant, it was termed the diffuse form. RESULTS. Intestinal dilatation of 2-8 mm was revealed on sonography in 21 fetus es with the isolated form of EDBL, Follow-up sonography showed resolut ion of EDBL in 20 cases, The outcome at birth was normal in 19 (90%) c ases, The 20th fetus was born with jejunal atresia, and the remaining fetus died after cordocentesis. Twenty-four fetuses with the complex f orm of EDBL also had intestinal dilatation of 2-8 mm shown on sonograp hy. Nine (38%) of these fetuses were born alive: six had gastroschisis ; two had meconium peritonitis; and one had vertebral defects, imperfo rate anus, tracheoesophageal fistula, and radial and renal dysplasia ( VATER). In these cases, resolution of EDBL was noticed at sonographic follow-up, Fourteen (58%) of the 24 fetuses were aborted. The remainin g fetus died after amniocentesis. The incidence of normalcy is compara ble in both local and diffuse dilatation. Amniocentesis was performed in 15 cases. Disaccharidase activity was measured in 13 patients. Low disaccharidase activity was detected in 10 (77%) of 13 cases. We saw c ystic fibrosis in none of the 45 fetuses. Infection was detected befor e and at birth in five (11%) cases. CONCLUSION. EDBL is a new entity t hat is most likely related to temporary obstruction, A fetus with the isolated form has a good prognosis, whereas a fetus with the complex f orm has an outcome directly related to the severity of associated abno rmalities.