Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years.

OBJECTIVE: To identify the fetal and neonatal imaging characteristics of meconium peritonitis (MP) and their clinical outcome. We also studied the role of prenatal ultrasound (US) in antenatal diagnosis and its use in predicting the need for surgical intervention postnatally. MATERIAL AND METHODS: We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014. RESULTS: Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range 19-31). Fetal ascites (93.3%) was the most common prenatal US finding. Of the 18 infants, 12 (66.7%) required surgical intervention. The overall survival rate was 94.4%. All infants with a prenatal US scan showing meconium pseudocyst or bowel dilatation required surgical intervention postnatally. DISCUSSION: A combination of ascites, intraperitoneal calcification, and echogenic bowel on fetal US raises a high suspicion of MP. Surgical intervention is indicated in the presence of meconium pseudocyst on fetal or postnatal US scan. Antenatal US has high specificity (100%) but low sensitivity (22.2%) in detecting meconium pseudocyst. A favorable outcome can be expected with early antenatal diagnosis and timely surgical intervention in a tertiary hospital.

A case of massive meconium peritonitis in utero successfully managed by planned cardiopulmonary resuscitation of the newborn.

We report a case of emergent massive meconium peritonitis due to intrauterine volvulus without malrotation. Fetal ascites was detected on a regular ultrasonographic examination, and fetal distress was found on cardiotocographic monitoring. The mother had noticed a slight decrease in fetal movements over the preceding 24 hours. Prenatal magnetic resonance imaging allowed us to distinguish the meconium from fetal peritoneal fluid and to evaluate the degree of compression of the fetal thoracic cavity. The infant was delivered by emergency cesarean section and demonstrated tense abdominal ascites with edema at birth. She required cardiopulmonary resuscitation and immediate paracentesis.

Repeated paracentesis in a fetus with meconium peritonitis with massive ascites: a case report.

Meconium peritonitis (MP) is defined as a sterile inflammatory reaction in the fetal abdomen that is seen in cases of intrauterine bowel perforation. Recently, there have been increasing numbers of fetuses with MP prenatally diagnosed by ultrasonography. Massive fetal ascites in MP may cause hydrops and hypoplastic lungs. However, antepartum management of MP has not yet been established. We encountered a fetus with MP and massive ascites. Repeated paracentesis between 29 weeks and 4 days and 31 weeks and 6 days of gestation prevented the progression to fetal hydrops and hypoplastic lungs, which may occur due to massive meconium ascites with an increased preload index. Amniocentesis was also performed in patients with polyhydramnios for treatment of preterm labor. These observations suggest that aggressive therapy can prolong the gestation period and improve MP treatment outcomes.

Meconium peritonitis. Pathology, evolution, and diagnosis.

The diagnosis of meconium peritonitis has received little attention in the pathology literature. Morphologic features of meconium peritonitis can be confusing to the pathologist unfamiliar with this specific entity, especially in case of extraperitoneal lesions presenting clinically as tumor nodules in the tunica vaginalis. Unfamiliarity with this entity can lead to unnecessary removal of the testis. This paper describes four cases of meconium peritonitis and reviews the literature on the pathology, evolution and diagnostic features of the disease, with emphasis on the healed stage, presenting as a tumor mass in the inguinal canal or tunica vaginalis.

New perspectives in fetal surgery: the chicken embryo.

After a short literature a review a comparison is made between the development of the human digestive tract during the second trimester of gestation and that of the chick embryo (Gallus domesticus) during the last week of incubation. The surgical procedure for chick embryosis is discussed in connection with the the study of the pathogenesis of small bowel atresia and meconium peritonitis. The results corroborate that the chick embryo is a valuable laboratory animal in experimental fetal surgery.

[Meconium peritonitis. A fetal catastrophe]. / Meconiumperitonitis. En katastrofe i føtallivet.

A material of 21 cases of meconium peritonitis treated by operation from 1972-1987 is presented. In four cases, intraabdominal anomaly was suspected on the basis of antenatal ultrasonography. The mortality was 19%. 57% developed symptoms during the first 24 hours, one at the age of one month and this case history is presented. Thirteen had intestinal atresia, 14 intrauterine volvulus, 7 open perforation, 13 pseudocyst, 1 gastroscisis. 2 had cystic fibrosis. Two patients are still attending the outpatient clinic on account of minor sequelae. The remainder have been discharged.

Can we select fetuses with intra-abdominal calcification for delivery in neonatal surgical centres?

BACKGROUND: Prenatal ultrasound (US) diagnosis of fetal intra-abdominal calcification (iAC) is frequently caused by an in utero perforation causing meconium peritonitis. Our ability to predict which fetuses will require postnatal surgery is limited. The aim of our study is to correlate iAC and associated US findings with postnatal outcome. METHODS: A single centre retrospective review of all cases of fetal iAC diagnosed between 2004 and 2010 was performed. Maternal demographics, fetal US findings, and outcomes (need for surgery and mortality) were collected. Descriptive and comparative statistical analyses were performed. RESULTS: Twenty-three cases of iAC were identified. There were no cases of fetal demise or postnatal deaths. Three liveborns (13%) required abdominal surgery at a median of 2 days (0-3) for intestinal atresia. US findings of iAC and dilated bowel with (p=0.008) or without (p=0.005) polyhydramnios predicted a need for postnatal surgery as did the combination of iAC, polyhydramnios, and ascites (p=0.008). Conversely, iAC alone or associated with oligohydramnios, polyhydramnios, ascites, or growth restriction did not predict need for postnatal surgery. CONCLUSION: The majority of fetuses with iAC on prenatal US do not require surgery. Associated US findings (bowel dilation) can be used to select fetuses for delivery in neonatal surgical centres.

An experimental study of the effect of an intestinal perforation at various developmental stages.

The effect of an experimentally induced intestinal perforation was studied in chick embryos. In 5 different groups of embryos a perforation was induced at 5 different developmental stages, while an equal number of sham operations was carried out for each stage. The results demonstrate that the effect of an intestinal perforation is determined by the developmental stage at which this perforation occurs. There was an inverse relationship between the developmental stage at which the perforation was induced and the remaining traces of the perforation site at the end of incubation. A perforation induced at an earlier developmental stage was more likely to lead to intestinal atresia coupled with only microscopic signs of meconium peritonitis. The severity of the adhesions increased concurrently with the developmental stage.

Fetal meconium peritonitis after maternal hepatitis A.

Hepatitis A virus has rarely been implicated in congenital infections. After maternal hepatitis A at 13 weeks' gestation, ultrasonographic examinations revealed fetal ascites (20 weeks) and meconium peritonitis (33 weeks). After delivery, a perforated distal ileum was resected. Elevated levels of hepatitis A immunoglobulin G persisted in the infant 6 months after delivery.

Meconium ileus and intestinal atresia in fetuses and neonates.

A collaborative study was performed to determine the different types and mechanisms of intestinal abnormalities during gestation. Cases had to fulfill one or more of the following three criteria: (1) meconium ileus, (2) intestinal stenosis or atresia, and (3) meconium peritonitis. Esophageal atresia, anorectal atresia, and abdominal wall defects were excluded. One hundred two cases were reviewed from the autopsies of 42 induced abortions, 22 stillborns, and the surgical findings in 38 neonates. Meconium ileus was detected mainly during the second trimester (28/38), and was associated with cystic fibrosis (15), fetal blood deglutition (4), infection (6), or multiple-abnormalities (10), in which three chromosomal aberrations were found. Intestinal stenosis or atresia was more commonly detected during the third trimester of gestation (46/56). Sixteen of the 30 duodenal malformations were associated with trisomy 21, whereas in the 26 small intestinal atresias, signs of distress or ischemia were most frequently detected. Only 8 of 25 meconium peritonitis cases were isolated. A total of 20 cystic fibrosis cases could be proved. In this series, functional abnormalities were observed predominantly in the second trimester and associated mainly with cystic fibrosis or amniotic fluid abnormalities. Anatomic lesions were commonly detected later on and associated with ischemic conditions, chromosomal aberrations, and even cystic fibrosis.

Meconium granulomas of the tunica vaginalis.

Meconium peritonitis results from perforation of the gastrointestinal tract during fetal life. Involvement of the tunica vaginalis may be the sole presenting clinical manifestation of the disease in the unusual event of the gut perforation resolving spontaneously. In such instances radiologically detectable calcification in the abdomen and scrotum is an essential diagnostic point. A case is described in which a baby had hydroceles and bilateral intrascrotal nodules but in which calcification was radiologically undetectable, presumably owing to its having undergon resolution. The typical histology of the nodules provided the diagnosis in this otherwise clinically undiagnostic case.

Antenatal diagnosis and management of meconium peritonitis: a case report and review of the literature.

We present a case of meconium peritonitis which was associated with a short bowel and complicated by progressive bowel distension and difficulty in making a definitive diagnosis of cystic fibrosis. Treatment was by bowel resection and an ileostomy (and later bowel anastomosis), followed by parenteral nutrition which was complicated by hepatitis. The literature is reviewed and management dilemmas and options are discussed.

[Meconium peritonitis and feto-fetal transfusion syndrome]. / Peritonite da meconio e sindrome da trasfusione feto-fetale.

A case of twin-to-twin transfusion syndrome with intrauterine death of one twin and meconium peritonitis and intravascular disseminated coagulation in the other twin is reported. Meconium peritonitis follows to bowel perforation, caused by segmental severe hypoplasia of muscular layer. The Authors suggest that this structural alteration of bowel wall could be an expression of inequal distribution of some cells between the two twins, during embrional development.