Absent gallbladder on fetal ultrasound: prenatal findings and postnatal outcome

Abstract

Objectives Fetal gallbladder non-visualization on prenatal ultrasound in the second trimester is uncommon and in most cases

Nonvisualization of the Fetal Gallbladder: Can Levels of γ-Glutamyl Transpeptidase in Amniotic Fluid Predict Fetal Prognosisγ

“…These findings concur with those of Dreux et al [6] who concluded that prior to 22 weeks of gestation, an abnormal pattern of amniotic fluid digestive enzymes had 90% sensitivity and 80% specificity in detecting CF or BA; however, after 22 weeks, the sensitivity dropped to 53%. In contrast, Shen et al [7] concluded that testing digestive enzymes in amniotic fluid is not justified for assessing cases of isolated NVFGB. However, their study included 21 fetuses with NVFGB, in which GGTP was found to be normal in all 5 cases in which it was assessed.…”

“…However, controversy exists regarding the yield of assessing GGTP levels of amniotic fluid in the prenatal diagnosis of fetuses whose gallbladder cannot be visualized [6,7,18,19,20]. This is mainly due to the rarity of BA, with a reported incidence of 1:20,000 live births [9], and the scarcity of reports on the prenatal diagnosis of BA.…”

“…The fetal gallbladder size increases during pregnancy, reaching a plateau at around 30 weeks [4,5]. In the majority of cases, in which the fetal gallbladder is not visualized on the early scan (0.1% of pregnancies), it is subsequently detected either later in pregnancy or after delivery by an ultrasound evaluation [1,2,6,7]. …”

“…Nonvisualization of the fetal gallbladder (NVFGB) may indicate gallbladder agenesis, without any serious clinical sequel [8], or it may be associated with a severe disorder such as extrahepatic biliary atresia (BA) [9,10], cystic fibrosis (CF) [11], chromosomal abnormalities [1,7,12], or other digestive tract disorders carrying a poor prognosis [13,14]. …”

Prenatal ultrasound diagnosis of cystic biliary atresia

“…It is a well‐described postnatal entity 2 associating biliary atresia and a portal cyst. Nonvisualization of the gallbladder during the second trimester ultrasound should prompt concern for BA 3, 4, 5. Other gallbladder abnormalities can be diagnosed prenatally such as agenesis, left‐sided, septated or bilobed gallbladder 6.…”