Conservative management after prenatal ultrasound diagnosis of meconium periorchitis

Abstract

Meconium periorchitis is caused by the leakage of meconium from a bowel perforation into the peritoneal cavity via a patent processus vaginalis into the scrotal sac during fetal life or in the early postnatal period. Intrauterine meconium peritonitis causes sterile inflammatory response and calcification. Here, we describe a prenatally diagnosed case of meconium periorchitis. During the ultrasound scan at 29 weeks' gestation, enlargement of the scrotum with many small hyperechogenic masses and normal anatomy of testis was observed. Our case is the 11th prenatally diagnosed case presented in the worldwide literature and the first one described in Poland. This case confirms the latest tendency for the conservative management of meconium periorchitis and an asymptomatic postnatal course.

Meconium periorchitis – An uncommon cause of perinatal scrotal swelling

“…The literature reports that 13% of all meconium periorchitis cases have associated congenital anomalies, including scrotoschisis, hypospadias, omphalocele or oesophageal atresia . Nine per cent of infants with meconium periorchitis test positive for cystic fibrosis.…”

“…On imaging, it is the presence of calcifications that raises the suspicion of scrotal neoplasm. Meconium periorchitis may mimic a testicular or paratesticular tumor – such as teratoma, rhabdomyosarcoma, metastatic neuroblastoma or lymphoma . In particular, the paratesticular and spermatic cord enlargement may simulate a paratesticular rhabdomyosarcoma …”

“…1 The literature reports that 13% of all meconium periorchitis cases have associated congenital anomalies, including scrotoschisis, hypospadias, omphalocele or oesophageal atresia. 7 Nine per cent of infants with meconium periorchitis test positive for cystic fibrosis. As a result, infants with meconium periorchitis undergo screening to exclude the presence of cystic fibrosis or associated abnormalities.…”

“…Meconium periorchitis may mimic a testicular or paratesticular tumor such as teratoma, rhabdomyosarcoma, metastatic neuroblastoma or lymphoma. 7 In particular, the paratesticular and spermatic cord enlargement may simulate a paratesticular rhabdomyosarcoma. 4 However, when both scrotal and abdominal calcifications are seen on radiographs and ultrasound, no diagnostic dilemma arises, as they are conclusive for meconium periorchitis.…”

Meconium periorchitis: An incidentally diagnosed rare entity during inguinal herniorraphy

“…Meconium is the greenish fetal intestinal content that contains swallowed amniotic fluid, lanugo, pancreatic and intestinal enzymes, bile salts and other cells. 1 Meconium causes an inflammatory reaction when it spreads into the peritoneal cavity because of an intrauterine intestinal perforation called meconium peritonitis. 1,2 The leakage of meconium into the scrotal sac through the patent processus vaginalis causes meconium periorchitis (MPO).…”