Echogenic bowel is diagnosed in 0.2% to 1.4% of second trimester 
ultrasonographic examinations. This finding occurs as a normal variant in the 
second trimester but also has been associated with several pathologic conditions 
that include cystic fibrosis, chromosomal abnormalities and in utero infection 
with cytomegalovirus and toxoplasmosis. Ultrasound assessment of echogenic bowel 
is usually subjective by comparing the echogenicity with adjacent bone or liver. 
The diagnosis of fetal echogenic bowel in the second trimester has significant 
implications for prenatal management. Fetal echogenic bowel should be considered 
an important marker of placental damage. This finding in the second trimester is 
strongly associated with adverse pregnancy outcome due to utero-placental 
insufficiency, particularly in women with elevated maternal serum 
alpha-fetoprotein concentration due to severe feto-maternal bleeding. This 
review focuses on the definition and diagnosis of this entity and problems 
raised by echogenic bowel due to subjectivity of the diagnosis. It also includes 
the pathophysiology in the different conditions and the prevalence of each 
condition. Based on this review, we suggest the evaluation that is needed, as 
well as the recommendations to follow-up, during the remaining term of pregnancy 
according to the literature.