Re: Second‐trimester intra‐abdominal bowel dilation in fetuses with gastroschisis predicts neonatal bowel atresia

Abstract

It was with great interest that we read the article by Nick et al.1 in a recent issue of the Journal. Similar results were published in our article, ‘Surveillance and outcome of fetuses with gastroschisis’2, and we strongly support the repeat findings by Nick et al., that intra-abdominal bowel dilatation is associated with bowel obstruction. In our paper2, comprising 64 fetuses with a prenatal diagnosis of gastroschisis, five fetuses had intra-abdominal dilatation of the bowel and all had bowel obstruction. These findings were also discussed extensively and images shown during an oral presentation at the ISUOG World Congress in New York in 20023. In the years following our publication2, studying 30 additional fetuses with gastroschisis, we have found further evidence that intra-abdominal bowel dilatation is a reliable marker for intestinal obstruction. Of these 30 fetuses, only one of those without intra-abdominal dilatation had bowel obstruction postnatally. Consequently, we rely on our ultrasound findings concerning the appearance of the fetal bowel when counseling the parents, and have done so for several years. In addition, the pediatric surgeons at our hospital are well aware of the reliability of these prenatal findings and use them to plan for the expected surgery. However, we have not found the outcome in terms of survival to be worse for the infants with bowel obstructions/atresias. The immediate morbidity in terms of hospitalization and time to full oral feeding is longer, but we have not observed any effect on the survival rate. In this context, we also want to emphasize the importance of delayed definitive bowel surgery following primary reduction en bloc in cases with massive peel and possible atresias, as we also discussed in our article2. In addition, it is important to note that a late developing intra-abdominal bowel dilatation may be associated with ‘closing gastroschisis’4, a rare, and if not handled correctly, fatal, complication. A. Brantberg*, H.-G. Blaas*, S. E. Haugen , S. H. Eik-Nes*, * National Center for Fetal Medicine, Department of Obstetrics and Gynecology, Norway, Department of Pediatric Surgery, St Olavs Hospital, Trondheim University Hospital, NO-7006 Trondheim, Norway