The meaning of intraabdominal bowel dilation in fetuses with gastroschisis

Article Outline

• References
• Copyright

To the Editors:

We read with great interest the article by Huh et al,¹ who reported their experience in the treatment of patients with a gastroschisis that was diagnosed antenatally. Their report concluded that prenatal intraabdominal bowel dilation (IBD) is associated with postnatal complication. Prediction of outcome in fetuses with gastroschisis remains an important issue in which prenatal IBD might prove useful. However, we do not believe that the data presented by Huh et al are supportive of such a conclusion at this stage.

The authors studied 43 cases retrospectively. Among these, 16 women had IBD. Our first concern is that the complications that were described cannot be considered to be postnatal, because they are related mainly to bowel atresia, which is a rare but well-described finding in the spectrum of gastroschisis.² On the other hand, necrotizing enterocolitis that was described in case 1 is indeed a postnatal complication; however, it could be related to prematurity, which is a potential confounding factor in this study because fetuses with IBD were delivered on average 2 weeks earlier (P = .006). Our second concern is that the authors failed to define IBD in the second or third trimester. Six of these infants (38%) had bowel complications, which is a significant proportion when compared with the group with no IBD (2/27 infants; 7%; P = .037). In that same case 1, IBD was only 4 mm in the second trimester and resolved at third trimester. This does not comply with the commonly accepted definition of IBD,³ and statistical difference would not hold when that case was reclassified into the “normal bowel” group (3/28 vs 5/15; P = .1).

IBD should be considered an ominous finding, which may prompt closer follow-up evaluation and treatment of fetuses with gastroschisis. However, we believe that it reflects mainly intestinal atresia, which is an associated prenatal intestinal anomaly rather than a postnatal complication.

Back to Article Outline

References 

1. Huh NG, Hirose S, Goldstein RB. Prenatal intraabdominal bowel dilation is associated with postnatal gastrointestinal complications in fetuses with gastroschisis. Am J Obstet Gynecol. 2010;202:396.e1–396.e6
   • View In Article
   • Abstract
   • Full Text
   • Full-Text PDF (678 KB)
   • Summary PDF (143 KB)
   • CrossRef
2. Nick AM, Bruner JP, Moses R, Yang EY, Scott TA. Second-trimester intraabdominal bowel dilation in fetuses with gastroschisis predicts neonatal bowel atresia. Ultrasound Obstet Gynecol. 2006;28:821–825
   • View In Article
   • MEDLINE
   • CrossRef
3. Parulekar SG. Sonography of normal fetal bowel. J Ultrasound Med. 1991;10:211–220
   • View In Article
   • MEDLINE