Pediatr Gastroenterol Hepatol Nutr.  2019 Nov;22(6):576-580. 10.5223/pghn.2019.22.6.576.

Meconium Peritonitis: A Rare Treatable Cause of Non-Immune Hydrops

• Rajendran
• Govindarajan J
• Balakrishnan U
• Chandrasekaran A
• Amboiram P

• KMID: 2462098
• DOI: http://doi.org/10.5223/pghn.2019.22.6.576

Abstract

Meconium peritonitis as a cause of non-immune hydrops in neonates is rarely reported. Here we report such a rare occurrence. In our case, a routine antenatal scan at 25 weeks revealed isolated ascites. By 31 weeks of gestation, all features of hydrops were observed in scans. However, antenatal workup for immune and non-immune hydrops was negative. Subsequently, a preterm hydropic female baby was delivered at 32 weeks. She required intubation and ventilator support. An X-ray revealed calcification in the abdomen suggestive of meconium peritonitis. Ultrasound showed gross ascites, a giant cyst compressing the inferior vena cava, and minimal bilateral pleural effusion. Emergency laparotomy revealed meconium pellets and perforation of the ileum. Double-barrel ileostomy was performed, and the edema resolved and activity improved. The baby was discharged after 3 weeks. Ileostomy closure was done at follow-up. The baby is growing well.

Keyword

Hydrops fetalis; Ascites; Newborn; Meconium; Peritonitis

MeSH Terms

Abdomen
Ascites
Edema*
Emergencies
Female
Follow-Up Studies
Humans
Hydrops Fetalis
Ileostomy
Ileum
Infant, Newborn
Intubation
Laparotomy
Meconium*
Peritonitis*
Pleural Effusion
Pregnancy
Ultrasonography
Vena Cava, Inferior
Ventilators, Mechanical

Figure

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  Fig. 1 Hydropic neonate at admission.

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  Fig. 2 X-ray showing intra-abdominal calcifications.

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  Fig. 3 Intra-operative finding of meconium pellets over the peritoneum.

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