Diagnostic Accuracy of Prenatal Ultrasound in Identifying Jejunal and Ileal Atresia

Abstract

Introduction: Small bowel atresia (SBA) is one of the most common causes of congenital intestinal obstruction. However, the accuracy of prenatal ultrasound in diagnosing this condition has not been entirely ascertained. The aim of this study was to analyse the predictive accuracy of ultrasound in detecting SBA prenatally. Methodology: Retrospective study of all cases with prenatal suspicion or postnatal confirmed SBA seen in a tertiary fetal medicine and pediatric surgery units from 2007 to 2013. Cases with duodenal atresia were excluded from the study. The predictive accuracy of ultrasound and different ultrasound signs, alone and in combination, was calculated. Results: 65 fetuses with prenatal suspicion or postnatal confirmed SBA were enrolled. 58 cases had full data and were included in the analysis. Predictive accuracy of ultrasound in detecting the presence of SBA was poor, with a sensitivity of 50% (95% CI 26.0-74.0) and a specificity of 70.59% (95% CI 52.5-84.9). The presence of both bowel dilatation ≥17 mm and polyhydramnios after 32 weeks of gestation slightly increased sensitivity (66.67%, 95% CI 34.9-90.1) and specificity (80.00%, 95% CI 44.4-97.5). Conclusions: In case of suspicion of SBA before the 3rd trimester, an ultrasound after 32 weeks should be performed to confirm the presence of both polyhydramnios and bowel dilatation >17 mm.

Apple‐peel jejunal atresia associated with multiple ileal atresias in a preterm newborn: A rare congenital anomaly

“…Due to the wide availability of ultrasonography, jejunoileal atresia is more frequently diagnosed prenatally, especially by detecting the presence of polyhydramnios and small bowel dilatation in the third trimester of pregnancy as demonstrated in our patient 7. This illustrative case also confirms the finding that jejunoileal atresia is accompanied with a high incidence of premature delivery 4…”

Fetal Bowel Dilatation: A Sonographic Sign of Uncertain Prognosis

“…Some obstructions may not be seen until the late second trimester [ 3 ]. The difference between dilated small bowel loops and colon by ultrasound imaging is challenging as is the accurate identification of the number and location of obstructions [ 4 , 5 ].…”

A new variant of type III jejunoileal atresia

“…JIA is being increasingly diagnosed by US in the prenatal period [9], although the detection rate is highly variable [10]. Despite being poor diagnostic criteria by themselves, the presence of polyhydramnios and small bowel dilation in the third trimester aid in the diagnosis of JIA [11]. As demonstrated in this case report, JIA is accompanied with a high incidence of premature delivery [12], and frequent prenatal evaluation is warranted.…”