Perinatology.  2017 Jun;28(2):29-34. 10.14734/PN.2017.28.2.29.

Clinical Features and Outcomes of Perinatally Diagnosed Meconium Peritonitis

Affiliations
  • 1Department of Pediatric Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. eyjung@dsmc.or.kr
  • 2Department of Obsterics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea.

Abstract


OBJECTIVE
Meconium peritonitis (MP) is defined as sterile chemical peritonitis, resulting from intrauterine bowel perforation. MP is rare but has high morbidity and mortality in neonates. We aimed to review the treatment and clinical course of MP, and to find out the possible relationship between perinatal parameters and outcomes.
METHODS
All patients diagnosed with MP between February 2006 and October 2016 were investigated retrospectively. MP was diagnosed with prenatal ultrasonography and the types of MP were identified intraoperatively. Findings of prenatal ultrasonography, gestational age, gender, birth weight, delivery type, APGAR score, clinical symptoms, causes of MP, mortality and morbidity, and hospital stay were analysed.
RESULTS
Thirteen patients were antenatally diagnosed with MP. Median gestational age was 37 weeks. All patients were diagnosed using prenatal ultrasonography. Calcification was found in 13 patients, bowel dilatation in 8, fetal ascites in 7, polyhydramnios in 6, and pseudocyst in 3. Five were females and 8 were males. Median birth weight was 2,930 g. Symptoms of abdominal distension were reported in 10 patients, bilious vomiting in 2, pneumoperitoneum in 2, and no symptoms and signs of MP in 1. One patient recovered with conservative management and the other 12 patients required surgery. All patients who underwent surgery had underlying pathologic causes; jejunoileal atresia, ileal perforation and transverse colonic perforation. Two cases of mortality occurred.
CONCLUSION
The mortality patients were haemodynamically unstable and had received preoperative pressor agents and ventilator care. More studies are needed to investigate the correlation between mortality and preoperative vital status.

Keyword

Fetal ultrasonography; Intrauterine bowel perforation; Meconium peritonitis; Prenatal sonography

MeSH Terms

Apgar Score
Ascites
Birth Weight
Colon, Transverse
Dilatation
Female
Gestational Age
Humans
Infant, Newborn
Length of Stay
Male
Meconium*
Mortality
Peritonitis*
Pneumoperitoneum
Polyhydramnios
Retrospective Studies
Ultrasonography, Prenatal
Ventilators, Mechanical
Vomiting

Figure

  • Fig. 1 Postnatal images and intraoperative findings (patient 1 in Table 2). (A) Postnatal plain X-ray; space occupying lesion in whole abdomen and bowels were positioned in left upper and lower quadrant. (B) Coronal image of computed tomography; fluid-containing cyst was seen and bowels were shifted to the left side. (C, D) Intraoperative findings; huge meconium cyst containing meconium and white calcification.


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