Meconium peritonitis in Nigerian Children

Abstract

Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal Xrays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.

Does Meconium Peritonitis Pseudo-Cyst Obstruct Labour?

“…It controlled the increased intra-abdominal pressure and improved respiratory and cardiovascular functions as reported by others [7, 13]. Therefore, in concordance with other's suggestions, early postnatal surgery of the infant is strongly advisable and can be associated with low mortality [13–15]. …”

Radiographic signs of gastrointestinal perforation in children: A pictorial review

“…[ 27 ] Calcifications can be seen along with features of free intra-peritoneal air. [ 28 ] Scrotal calcifications arising due to the passage of meconium through the patent processus vaginalis have also been reported as a radiographic sign that can suggest in-utero bowel perforation. [ 29 ]…”

Value of prenatal diagnosis of meconium peritonitis

“…[6,7,9] However, the mortality rate of MP remains as high as 50% in underdeveloped countries. [14] As diagnostic modalities evolve, the accuracy of prenatal diagnosis has improved. It is logical that the survival and morbidity rates could be greatly ameliorated if MP is antenatally detected and appropriately managed during the immediate postnatal period.…”