Echogenic Bowel is essentially an ultrasound finding, wherein the fetal bowel displays an increased echogenicity usually during a scan in the second trimester. It is important to assess this since it is an important marker for several disorders. Normally, the fetal intestine appears grey-black in a sonographic scan .When it is much brighter, it is referred to as an echogenic bowel. It is observed in less than 2% of all scans and the outcome is usually normal.

Significance :
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In many instances, an echogenic bowel is the ONLY pointer to an underlying disease ,especially chromosomal abnormalities, cystic fibrosis and intra-uterine growth retardation (i.e may or may not present other findings ) which can seriously affect the development of the fetus.

Reasons for the Hyperechogenicity :
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The hyperechoic shadow of the intestine could be due to the following reasons :-
1) If the foetus has swallowed amniotic fluid containing blood, its remnant residual iron creates such a shadow - this will usually resolve in a few weeks.
2) When meconium becomes abnormally viscous due to either obstruction, lowered motility or other reasons.
3) Due to redoced blood supply to the area.
4) A condition called meconium perotonitis due to a bowel perforation.
5) Finally, the foetus may have swallowed blood itself.

Causes of Echogenic Bowel :
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Echogenic Bowel is usually associated with the following conditions :

A) Chromosomal Abnormalities : such as Down syndrome and less frequently Turner's syndrome and triploidy. Especially when associated with other significant sonographic findings, the risk of these conditions is high.
B) Cystic fibrosis (CS) : An Echogenic Bowel is the most predictive marker for CS in high -risk patients for CF whereas it is usually insignificant in low-risk groups.
C) Intra-Uterine growth Retardation(IUGR)-when associated with echogenic bowel holds a poor prognosis for the fetus.
D) Intra-amniotic hemorrhage, growth within the bowel or abnormally developing bowel.
E) Rarely , associated with congenital Infections like Cytomegalovirus (CMV), Toxoplasmosis or parvovirus or with Thalassemia .

Recommended Investigations :
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1) A further thorough sonographic study as a first step.
2) Amniocentesis for karyotype as a must.
3) CF carrier status testing of both parents
4) Serological testing of mother's blood to rule out CMV , Toxoplasmosis.
5) All these foetuses should be monitored with serial growth scans since they are at a higher risk of growth retardation.

An Echogenic bowel, although mostly insignificant, needs to be monitored carefully.