NON-VISUALIZATION OF THE FETAL STOMACH

Failure to visualize the fetal stomach after 14-15 menstrual weeks necessitates a careful examination and follow-up scan. Non-visualization occurs in 0.4% of all fetal examinations (1), and is probably due to the period of physiological gastric emptying.

CONDITIONS ASSOCIATED WITH GASTRIC NON-VISUALIZATION

1. Transient finding due to normal physiological emptying.
2. Esophageal atresia.
3. Diaphragmatic hernia.
4. Oligohydramnios.
5. Impaired fetal swallowing:
• Oropharyngeal mass.
• CNS abnormalities.
• Facial clefts.
• Neuromuscular disorders.
6. Abnormal location.
• Congenital diaphragmatic hernia.
• Situs abnormality.
7. Severe IUGR (secondary to severe oligohydramnios).
8. Chromosomal abnormalities:
• Wolf-Hirschhorn syndrome (deletion 4p; diaphragmatic hernia).
• Pallister-Killian syndrome (tetrasomy 12p; diaphragmatic hernia).
• Trisomy 9 (diaphragmatic hernia).
• Edwards syndrome (trisomy 18; tracheo-esophageal fistula).
9. Other syndromes:
• CHARGE association (tracheo-esophageal fistula).
• Fryns syndrome (diaphragmatic hernia).
• Marfan syndrome (occasional diaphragmatic hernia).
• VATER association (tracheo-esophageal fistula).

Pretorius (2) Millener (1) McKenna (3)

Absent stomach >19 weeks. Absent stomach >14 weeks. Absent stomach. Small stomach.

Abnormal outcome in 100%. Abnormal outcome in 48%. Abnormal outcome in 85%. Abnormal outcome in 52%.

After observing a small stomach, follow up demonstrated a normal stomach in 77% and 88% had a normal outcome.

REFERENCES

1. Millener PB, Anderson NG, Chisholm RJ. Prognostic significance of nonvisualization of the fetal stomach by sonography. AJR 1993;160:827-830.
2. Pretorius D, Gosink B, Clautice-Engle T et.al. Sonographic evaluation of the fetal stomach: Significance of non-visualization. AJR 1988;151:987-989.
3. McKenna K, Goldstein R, Stringer M. Small or absent fetal stomach: Prognostic significance. Radiology 1995;197:729-733.