An unusual cause of meconium peritonitis in a foetus

Abstract

Meconium peritonitis is a sterile chemical peritonitis resulting from intestinal perforation in-utero. We present a preterm male neonate weighing 1820 g in whom foetal meconium peritonitis was diagnosed by antenatal utrasonogram. Examination of the newborn in the immediate postnatal period revealed a firm lump of size 5 x 3 cm in the right lumbar and umbilical area. Rest of the abdomen was normal without any clinical evidence of intestinal obstruction. X-ray of abdomen done at 3 hours of life showed a cystic mass with calcified margin. Ultrasonography of abdomen ruled out any definite cause of intestinal obstruction and perforation. He was kept on conservative management. At 11 hours of life the neonate passed a small sticky white mucus plug per rectum followed by black colored meconium of normal consistency 2 hours later. The bowel habit remained regular thereafter. Screening for intrauterine infections and cystic fibrosis was negative. He is under regular follow-up and is now 6 months old with normal bowel habit. A lump of size 2 x 2 cm is still palpable and a small calcified mass is persistent in x-ray. Role of an intestinal mucus plug as the potential factor for intestinal obstruction and subsequent perforation has been highlighted in the present case.

Post natal rupture of meconium pseudocyst in a neonate with delayed diagnosis

“…If the intestinal continuity is maintained it may get sealed off and gradually heal without any intervention and the cyst size may gradually regress. 5 but if there is persistent communication it may enlarge is size to form a giant cystic Meconium peritonitis or perforate. We could find only two previous case report of pseudocyst with Pneumoperitonium in literature.…”

Meconium Peritonitis: Antenatal Diagnosis and Management. Two Case Reports

“…Fetal MRI can be a useful tool in describing the exact pathology and comorbidities, even if it's not needed in all cases [1].…”

“…Meconium peritonitis (MP) is defined as an aseptic, localized or generalized peritonitis due to leakage of meconium into the peritoneal cavity, secondary to bowel perforation in utero. Peritonitis caused by postnatal gastro-intestinal perforations even if meconium is involved is not included in the diagnosis of MP [1].…”

“…It is composed of amniotic fluid with bile salts, cell debris and proteins, uric acid, intestinal enzymes, cholesterols, inorganic salts and sugar. Bowel perforation will induce chemical peritonitis triggered by bile salts and enzymes (such as lipase) spilled into the abdominal cavity [1]. The immediate result is inflammation through the release of chemical mediators causing phagocytosis, especially TNF-production which is reported to remarkably increase when the peritoneum encounters meconium.…”

“…Bowel hypoxia seems to be the main factor, but no consensus has been achieved. The main etiological factors are: intestinal atresia, intestinal volvulus and meconium ileus related to cystic fibrosis [1].…”