Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach‐down left congenital diaphragmatic hernia

Abstract

Recognition of the fetal stomach and/or gallbladder in contact with the bladder wall can help in the detection of stomach-down left CDH. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:8-13, 2017.

Prenatal ultrasound diagnosis of ‘stomach‐down’ left congenital diaphragmatic hernia

“…Morgan et al . hypothesized that this remarkable finding was due to the absence of bowel in the abdomen 3 . In agreement with this hypothesis, the only other condition in which we have observed the stomach to be in contact with the bladder is gastroschisis (Figure 2; unpubl.…”

“…Moreover, based on our series, Morgan et al reviewed retrospectively a large cohort of pregnancies with CDH and similarly found that the stomach was in contact with the bladder in two-thirds (15/22; 68%) of the subset of fetuses with stomach-down left CDH 3 that the gallbladder was in contact with the bladder in 75% of cases. Morgan et al hypothesized that this remarkable finding was due to the absence of bowel in the abdomen 3 . In agreement with this hypothesis, the only other condition in which we have observed the stomach to be in contact with the bladder is gastroschisis (Figure 2; unpubl.…”

“…In nine cases with stomach-down left CDH, we found that two-thirds had an unusual finding: the stomach in contact with the bladder (Figure 1) 2 . Moreover, based on our series, Morgan et al reviewed retrospectively a large cohort of pregnancies with CDH and similarly found that the stomach was in contact with the bladder in two-thirds (15/22; 68%) of the subset of fetuses with stomach-down left CDH 3 that the gallbladder was in contact with the bladder in 75% of cases. Morgan et al hypothesized that this remarkable finding was due to the absence of bowel in the abdomen 3 .…”

“…In conclusion, the stomach being in contact with the bladder is an easy‐to‐identify ultrasound sign and can be helpful in detecting this subtype of fetuses with stomach‐down left CDH 2,3 .…”

Reply

“…We agree that abnormal orientation of the stomach resulting in it being in contact with the urinary bladder can be seen in 'stomach-down' left congenital diaphragmatic hernia (CDH). In our cohort, we identified this finding on ultrasound and, when available, magnetic resonance imaging (MRI) in 12/28 (42.9%) fetuses with stomach-down left CDH, which is slightly lower than the previously reported incidence 2,3 . Interestingly, we identified that gestational age was greater in fetuses with the stomach in contact with the bladder compared to those without (mean, 34 + 5 weeks vs 28 + 6 weeks; P < 0.01), suggesting that increased stomach distension and shift of intra-abdominal content over the course of gestation may be a contributing factor.…”