A. G. Kim1,2, D. R. Berman2,3, J. Kreutzman2,3, M. C. Treadwell2,3, G. B. Mychaliska1,2, E. E. Perrone1,2 1University Of Michigan,Department Of Surgery, Section Of Pediatric Surgery,Ann Arbor, MI, USA 2University Of Michigan,Fetal Diagnosis And Treatment Center,Ann Arbor, MI, USA 3University Of Michigan,Department Of Obstetrics And Gynecology, Division Of Maternal-Fetal Medicine,Ann Arbor, MI, USA
Introduction:
Advances in prenatal imaging results in increasing detection of abnormally dilated bowel. There is no literature to date focusing on the clinical significance of a dilated rectum. We hypothesized that the majority of antenatally identified cases of a dilated rectum are normal variants, but certain characteristics may be more often associated with pathology.
Methods:
A retrospective chart review was performed on all patients in whom “dilated bowel” was identified on prenatal ultrasound between January 2000 and December 2017 at a single institution, excluding cases of prenatally diagnosed ventral wall defects. Data including diagnoses, surgeries, and outcomes were collected. Descriptive statistics were used.
Results:
193 cases of “dilated bowel” were identified in which 12 (6.2%) had specifically visualized a dilated or prominent rectum. Nine of these (75.0%) had no rectal or intestinal abnormality on postnatal evaluation and were discharged feeding and defecating normally. Three cases required further work-up and management in the neonatal period: 1) meconium plug, 2) jejunal atresia with cecal perforation, and 3) rectal perforation with retroperitoneal abscess. All three had rectal biopsies with identification of ganglionated submucosa.
Conclusion:
Although a prenatally dilated rectum is a normal variant in the majority of cases, it may be associated with a gastrointestinal abnormality requiring surgical intervention. Interestingly, there were no cases of Hirschsprung’s disease in this cohort. These results in conjunction with continued efforts to identify and measure rectal and large bowel dilation are useful for prenatal counseling and postnatal evaluation.