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

Abstract

Meconium peritonitis is a rare fetal disease with an increased rate of morbidity and mortality in the neonatal period. Meconium pseudocyst is a complication of meconium peritonitis which is a sterile chemical peritonitis due to intrauterine bowel perforation. When the perforation in the intestine does not heal and communication with the cyst persist postnatal that can lead to cyst expansion, infection of the cyst or rupture of pseudocyst. This is a case report of a neonate with rupture of meconium pseudocyst causing perforation peritonitis. There was a delay in diagnosis in our case, but was successfully managed with staged enterostomy.

Intra-Uterine Perforation Presented as a Giant Cystic Abdominal Mass in a Neonate: A Giant Meconium Pseudocyst

“…A meconium pseudocyst is formed following a meconium leak, that is, intrauterine bowel perforation leading to enteric secretions that come in contact with the peritoneal cavity causing a fibrous reaction. It is essentially a fibrous wall formation around the leaked meconium, which is majorly following antenatal bowel obstruction and perforation secondary to meconium ileus, bowel atresia, intussusceptions, Meckel's diverticulum, Hirschsprung's disease, idiopathic cause, and sigmoid volvulus [6] It may present as a palpable abdominal lump, progressive abdominal distension, respiratory distress, or sepsis. According to the meta-analysis conducted by Shinar et al [7] on fetal meconium peritonitis, prenatal diagnosis was primarily made in the late second or early third trimester, with diagnosis at a mean gestational age of 28.1 ± 2.5 weeks; the strongest indicator of postnatal surgery was meconium pseudocyst.…”

“…A meconium pseudocyst is formed following a meconium leak, that is, intrauterine bowel perforation leading to enteric secretions that come in contact with the peritoneal cavity causing a fibrous reaction. It is essentially a fibrous wall formation around the leaked meconium, which is majorly following antenatal bowel obstruction and perforation secondary to meconium ileus, bowel atresia, intussusceptions, Meckel’s diverticulum, Hirschsprung’s disease, idiopathic cause, and sigmoid volvulus [ 6 ]…”