Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia

OBJECTIVE: Esophageal atresia may be diagnosed prenatally by ultrasonograph ic visualization of the blind-ending esophagus during fetal swallowing, whi ch is referred to as the pouch sign. Our purpose was to determine whether t his sign can be used to predict outcomes of affected fetuses. STUDY DESIGN: Four cases of esophageal atresia diagnosed in our center duri ng the past 2 years were analyzed, in conjunction with 3 cases from publish ed series. Ultrasonographic features of the pouch sign were categorized acc ording to localization. RESULTS: In the neck pouch group (n = 3) 1 fetus died in utero and 1 died b efore a corrective operation could be undertaken. In the only fetus of this group to survive a staged repair was necessary because of a long atretic g ap. Conversely, 3 of the 4 fetuses with a mediastinal pouch survived after a successful corrective operation, and primary repair was possible in all c ases. CONCLUSIONS: The base of the proximal blind-ending esophagus can be clearly localized by means of ultrasonography. Our data suggest that a neck pouch may be associated with an adverse outcome. This information may be useful i n counseling parents when esophageal atresia is diagnosed prenatally.