Experience with meconium peritonitis

doi:10.1016/j.jpedsurg.2007.07.006

Journal of Pediatric Surgery

Volume 42, Issue 11, November 2007, Pages 1822-1825

https://doi.org/10.1016/j.jpedsurg.2007.07.006 Get rights and content

Abstract

Background

Meconium peritonitis is a sterile chemical peritonitis resulting from intrauterine bowel perforation. With the development of neonatal care, the prognosis of meconium peritonitis improved much. We report our clinical experience.

Methods

The medical records of patients with meconium peritonitis admitted to the Asan Medical Center from June 1989 to July 2006 were retrospectively reviewed.

Results

Of 41 patients (17 males, 24 females), 38 (92.7%) were suspected to suffer from meconium peritonitis prenatally, at a median gestational age of 32 weeks (range, 21-40 weeks). The most common prenatal sonographic finding was fetal ascites followed by dilated bowel. Ten patients were managed conservatively, but 31 patients underwent operations including resection and anastomosis (22), drainage procedure (4), ileostomy (3) and primary repair (2). The operative 31 cases comprised generalized (16), fibroadhesive (10), and cystic types (5). The main causes were intestinal atresia and idiopathic bowel perforation. The mortality rate was 2.4%, and the morbidity rate was 34.1%.

Conclusions

Good survival rate was achieved. But there was rather high morbidity. More gentle and delicate approach should be done to lower the morbidity.

Section snippets

Patients and methods

A retrospective study was done on a total of 41 patients (17 males, 24 females) with meconium peritonitis at the neonatal intensive care unit of Asan Medical Center from June 1989 to July 2006. Patients were referred to pediatric surgeons if abdominal distention, bilious vomiting, or pneumoperitoneum was noted. Asymptomatic patients, even with radiographic evidence of calcifications or localized fluid collection on ultrasonography, were placed on slow feeding regimens and received attentive

Results

The median gestational age of patients was 36 weeks (27⁺⁴-40⁺³ weeks), and 25 patients were premature babies. The median birth weight was 2776 g (range, 1249-4110 g); 12 patients weighed below 2500 g, and 2 patients, below 1500 g. The median maternal age was 29 years (range, 19-37 years). Prenatal diagnosis of meconium peritonitis was made in 38 patients (92.7%) at a median gestational age of 32 weeks (range, 21-40 weeks). The most common prenatal ultrasonographic finding was fetal ascites (16

Discussion

In 1953, Bendel and Michel [5] defined meconium peritonitis as a nonbacterial and chemical peritonitis occurring during intrauterine or early neonatal life because of an abnormal communication between the bowel lumen and peritoneal cavity. It was a very rare disease occurring in one per 30 000 live births [2], [3], [4]. Although many investigators have studied the pathogenesis of meconium peritonitis, it is not yet well understood [6], [7]. A decrease in blood flow to the mesentery may lead to

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Giant cystic meconium peritonitis (MP) is a relatively rare entity. Prompt surgical treatment is required to manage the underlying etiology and reestablish the continuity of the intestines. Despite perinatal and postoperative care improvements, the overall mortality rate is still relatively high. We reported a giant cystic MP that was recognized using antenatal sonography (US). It was successfully treated with primary anastomosis.
We presented a female newborn with a chief complaint of abdominal mass. The prenatal sonography showed an intraabdominal cyst at the 28th week of gestation. She was born at the gestational age of 38 weeks via vaginal delivery from a primigravid mother without complications, with a birth weight of 3275 g. Elective surgery was performed at the age of eight days, and a calcified 10 cm cyst was revealed along with severe adhesions. The cyst was found to communicate with the ileum located 30 cm proximal from the ileocecal junction. No malrotation and volvulus were found. The cyst and a portion of the ileum were resected, followed by a primary end-to-end anastomosis. Pathologic examination showed necrotic tissue lined with epithelial tissue with microcalcifications containing bilirubin pigments, consistent with cystic MP. The patient has uneventfully discharged on postoperative day 17. The patient has normal growth and development, except for delayed walking, at the last follow-up of two years of age.
Giant cystic MP is a rare disorder that can be detected early using the antenatal US. Our case highlights the importance of early diagnosis for giant cystic MP using the antenatal US leads to prompt surgical treatment and a more favorable prognosis.
A case of intestinal failure associated with meconium peritonitis requiring transanal decompression using a Kangaroo New Enteral Feeding Tube
2022, Journal of Pediatric Surgery Case Reports
Meconium peritonitis is a congenital disorder characterized by intestinal perforation in utero and presents as sterile chemical peritonitis. When intraabdominal chemical inflammation is severe, intestinal decompression may be required to control intestinal failure due to severe adhesions. In this case, we safely controlled intestinal failure by transanal decompression using a Kangaroo New Enteral Feeding Tube (EF tube) because oral intestinal adhesions were severe and conventional transoral decompression was not feasible. Given the risk of anastomotic leakage and the potential time needed to improve intestinal failure, transanal decompression by EF tube should be considered when transoral decompression proves difficult.
Meconium peritonitis: A 22-year review in a tertiary referral center
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Meconium peritonitis (MP) is a sterile, chemical peritonitis resulting from in-utero fetal bowel perforation. Severe cases may lead to serious morbidities and mortalities.
To review the common antenatal ultrasound abnormalities associated with MP, and identify radiological and clinical prognostic factors.
Retrospective review of all neonates with MP from January 1997 to December 2019 treated in our hospital was performed. Antenatal ultrasound findings, clinical presentations and outcomes were analyzed.
Thirty-five neonates (17 males, 18 females) were included in the study. Thirty-two (91.4%) attended antenatal screening, and 27 (84.4%) of them had abnormalities identified on antenatal ultrasound. The most common abnormality was polyhydramnios (43.8%). Nineteen (54.3%) patients were inborn. Twenty (57.1%) patients were born prematurely. Laparotomy was required in 85.7% of patients. The median time to laparotomy was shorter in the inborn group [1 day (0–9 days) vs 4 days (2–34 days), p = 0.001], but the duration of post-operative hospital stay was comparable [71 days (16–423 days) vs 73.5 days (23–231 days)]. However, such duration was found to be significantly longer in the pre-term group when compared to full-term [58.5 days (16–89 days) vs 85 (21–423 days), p = 0.01]. The most common pathology was small bowel atresia and there were two mortalities.
Due to the advancement in prenatal detection, pediatric anesthesia, intensive care and surgical techniques, the morbidity and mortality of MP has much decreased. Effective multi-disciplinary antenatal counseling facilitated the perinatal management of MP and resulted in comparable prognosis and outcome in inborn and outborn neonates.
3
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Citation Excerpt :
Most cases of meconium peritonitis are thought to be idiopathic that result from either mesenteric ischemia, volvulus, intestinal atresia, cystic fibrosis, Hirschsprung's Disease, or colonic atresia with subsequent bowel necrosis and perforation [4–8]. The mortality rate for meconium peritonitis was as high as 70% [9] but more recently has dropped to 10% [10]. This improvement is primarily due to advancements in management and fetal diagnostic techniques [11,12].
Meconium pseudocyst presenting as massive ascites in a new-born
2019, Radiology Case Reports
Meconium pseudocyst (MPC) is a rare but well-known surgical condition due to prenatal bowel perforation. A case of MPC secondary to prenatal bowel perforation is presented. Massive ascites requiring peritoneal drainage and disappearance of prenatal intraperitoneal calcifications have not been previously reported in MPC. MPC may present at birth with large ascites requiring peritoneal drainage to establish breathing and ventilation. Absence of prenatal intra-abdominal calcifications does not rule out MPC.

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Original articleExperience with meconium peritonitis

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

J Pediatr Surg

J Pediatr Surg

Hum Pathol

J Urol

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Meconium peritonitis: conclusions based on 53 cases

Cir Pediatr

Meconium peritonitis secondary to torsion of fallopian tube cyst and transient central diabetes insipidus in a preterm infant

J Perinat Med

Meconium peritonitis: changes in fetal C-reactive protein and CA 125 levels in relation to stage of disease

J Ultrasound Med

Original article
Experience with meconium peritonitis