Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia.
OBJECTIVE
Esophageal atresia may be diagnosed prenatally by ultrasonographic visualization of the blind-ending esophagus during fetal swallowing, which is referred to as the pouch sign. Our purpose was to determine whether this sign can be used to predict outcomes of affected fetuses.


METHODS
Four cases of esophageal atresia diagnosed in our center during the past 2 years were analyzed, in conjunction with 3 cases from published series. Ultrasonographic features of the pouch sign were categorized according to localization.


RESULTS
In the neck pouch group (n = 3) 1 fetus died in utero and 1 died before a corrective operation could be undertaken. In the only fetus of this group to survive a staged repair was necessary because of a long atretic gap. Conversely, 3 of the 4 fetuses with a mediastinal pouch survived after a successful corrective operation, and primary repair was possible in all cases.


CONCLUSIONS
The base of the proximal blind-ending esophagus can be clearly localized by means of ultrasonography. Our data suggest that a neck pouch may be associated with an adverse outcome. This information may be useful in counseling parents when esophageal atresia is diagnosed prenatally.
Kalache
K D
KD
Unit of Fetal Medicine, Clinic of Obstetrics and Gynecology, Campus Charité Mitte, University Hospital-Medical Faculty of the Humboldt University, Berlin, Germany.
Wauer
R
R
Mau
H
H
Chaoui
R
R
Bollmann
R
R
D004933:Esophageal Atresia / Q000000981:diagnostic imaging* / Q000196:embryology* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D011296:Prenatal Diagnosis; D011379:Prognosis; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal