Non-visualization of the gallbladder on fetal ultrasound: Prenatal findings and postnatal outcome Oya Demirci, Güher Bolat, Mucize Özdemir, Ayşenur Celayir Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Perinatology Department

Case 26 years old primigravida woman. At 22 weeks’ gestation on detailed examination Hyperechogenic fetal bowel was seen. The gallbladder could not be visualized. Amniocentesis was performed at 23  weeks

Normal karyotype was established. CFTR gene mutation was not detected. Ƴ-glutamyl transpeptidase and intestinal alkaline phosphatase were investigated. Normal development or bening gallbladder agenesis Severe anomaly such as biliary atresia.

Amniotic fluid digestive enzyme activities gamma-glutamyl transpeptidase (GGTP) value : At the 10 th percentile Intestinal alkaline phosphatase : Low value.

37 weeks, 2780 g female neonate Normal clinical and biochemical findings On postnatal ultrasound examination : The small gallbladder Normal bile duct and common hepatic duct

Conclusion Non-visualization of the fetal gallbladder Associated with: Gallbladder agenesis Biliary atresia Cystic fibrosis Chromosomal abnormalities

Genetic consultation Amniocentesis for fetal karyotyping Screening for a CFTR gen mutation Analysis of digestive enzymes GGTP and intestinal alkaline phosphatase

Before 22 weeks' gestation Low amniotic fluid digestive enzyme activities →Biliary atresia After 22 weeks’ gestation Low amniotic fluid digestive enzyme activities →Physiological

Result Our case, Low intestinal alkaline phosphatase level Normal bile duct, common hepatic duct This result may be due to Amniosentesis after 22 weeks’ gestation