Hyperechoic Bowel & Meconium

Both hyperechoic bowel and the less common hyperechoic meconium have been reported in the second and third trimesters. These diagnoses have been associated with a variety of prenatal diagnoses, including cystic fibrosis, bowel atresias, aneuploidy, fetal growth retardation and intrauterine fetal demise, according to specialists at the University Center for Fetal Medicine. However, both can be normal findings as well. 

Evaluation

Due to the increased risk of fetal complications in the setting of hyperechoic bowel or meconium, a detailed fetal ultrasound and serial follow-up ultrasounds are necessary to rule out associated anomalies and to assess maternal and fetal well-being. Amniocentesis for karyotyping and cystic fibrosis screening should be offered as well.  

Treatment

If no underlying cause is found and the abnormality persists until birth, delivery at a tertiary care center is advised as immediate assessment by a pediatric surgeon is needed. A detailed postnatal physical examination, abdominal ultrasound and radiographs (X-rays) of the abdomen should be performed. If no other abnormality is found on these studies, the neonate can be fed and observed for normal passage of meconium.

In a series looking at hyperechoic bowel, a high risk of bowel atresia, cystic fibrosis, aneuploidy and intrauterine fetal demise has been found. Of the infants with hyperechoic bowel, 73 percent were normal at birth. Prenatal diagnosis of hyperechoic meconium can have both normal and abnormal outcomes.


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