Search

Background. Meconium ileus is one of the manifestations of cystic fibrosis. It is characterized by intestinal obstruction with viscous meconium leading to perforation and peritonitis. The issues of early diagnosis of cystic fibrosis, management of newborns with meconium ileus and negative neonatal screening for immunoreactive trypsinogen (IRT), as well as IRT decrease causes and mechanisms in patients with meconium ileus require further study. Clinical case description. Routine ultrasound examination at the 33rd week of gestation has shown signs of colon obstruction and meconium peritonitis in the intrauterine child. Surgical treatment of peritonitis was performed urgently on the 1st day after birth. The child was on mechanical ventilation from the 1st day of life. The child has shown signs of intrahepatic cholestasis with direct hyperbilirubinemia (up to 100 μmol/L) and signs of hemorrhagic syndrome (bleeding from injection sites) on the 8th day of life. Negative IRT blood test was received (21.6 ng/mL, normal value < 70 ng/mL) on the 10th day. The fecal elastase concentration was 45 μg/g (normal value > 200 μg/g) (on the same day). Sweat tests were performed on the 21st and 23rd days of life. They have shown high levels of sweat chlorides (112 mmol/L in both samples, normal value — 30–59 mmol/L). The diagnosis of «cystic fibrosis» was established, thus, dornase alfa (dosage — 2.5 mg/day) was added to the therapy. Conclusion. Meconium ileus is one of the specific intestinal manifestations of cystic fibrosis and it commonly can be complicated with intestinal perforation in the intrauterine child with further peritonitis. Children with meconium ileus require sweat tests regardless the neonatal screening results.

Objective: To evaluate whether infants with prenatal diagnosis of meconium peritonitis (MP) have a poorer prognosis. Methods: A retrospective analysis of data from infants treated with surgery from January 2008 to December 2020 was conducted. The patients were divided into prenatal diagnosis group and postnatal diagnosis group based on the timing of diagnosis. The intraoperative and postoperative parameters of the two groups of patients were compared. Results: A total of 71 cases of MP were included in the study, with 48 cases in the prenatal diagnosis group and 23 cases in the postnatal diagnosis group. The comparison of preoperative indicators between the two groups of patients showed no statistically significant differences in baseline (p > 0.05). Intraoperative indicators, including blood loss, anastomosis, retained intestinal tube length and excised intestinal tube length, showed no statistically significant differences between the two groups (p > 0.05). However, the postnatal diagnosis group had a significantly shorter operation time than the prenatal diagnosis group (p < 0.05). Postoperative indicators, including fasting time, albumin usage, complications, and abandonment or mortality rates, show no difference (p > 0.05). Nevertheless, the postnatal diagnosis group exhibited significantly shorter hospital stay and time to first bowel movement compared to the prenatal diagnosis group (p < 0.05). Conclusion: Prenatal diagnosis of meconium peritonitis is associated with increased surgical complexity, prolonged hospital stay, and delayed recovery of intestinal function. However, there is no evidence of higher mortality or more complications compared to infants diagnosed postnatally, and there is no significant difference in long-term prognosis. [ABSTRACT FROM AUTHOR]

According to various scientists, 10-20 percent of newborns with cystic fibrosis have meconium ileus (MI). MI is an obstruction of the small intestine that occurs in fetuses during the 20th-24th week of gestation due to a violation of the processes of the formation of meconium. The latter has an increased viscosity and cannot pass through the intestines causing their obturation. About 50 percent of the cases of MI are complicated by intestinal volvulus, intestinal atresia, malrotation, perforation with the development of meconium peritonitis and ascites, the formation of a meconium pseudocyst etc. The goal of the research is to conduct a systematic overview of the literature on the issue of MI in neonatal patients and to offer optimal tactics of medical support of newborns with MI on the basis of the analysis of relevant literary sources and our own observations related to this topic. The Results. The overview of the literature in the historical aspect covering the last 20 years has demonstrated the following: due to the development and improvement of the methods of conservative surgical treatment of newborns with MI the mortality of the newborns with MI has decreased. The analysis of the data based on the global experience as well as on our own observations indicates the possibility of conservative therapy and surgical treatment of infants with MI and testifies to the fact that in 50 percent of cases of uncomplicated MI the conservative treatment can be an effective option. The research contains the description of the step-by-step measures of conservative treatment. The indications for surgical interventions have also been specified in the research. Conclusion. In treatment of newborns with MI resections and stomata should be avoided. Instead, preference should be given to gastric lavage. [ABSTRACT FROM AUTHOR]

Objective：To explore the value of imaging in the diagnosis of neonatal meconium peritonitis and the selection of treatment methods. Methods：We retrospectively analyzed the clinical, ultrasound and radiological manifestations and treatment results of 83 neonates, which were diagnosed as meconium peritonitis, from January 2018 to December 2022. The children were divided into the surgical group and the non ⁃ surgical group, and the manifestations on ultrasound and X ⁃ ray examination such as peritoneal calcification, meconium pseudocyst, intestinal obstruction, volvulus, ascites, and pneumoperitoneum were analyzed. Results： Eighty three neonates (48 males and 35 females)were diagnosed as meconium peritonitis in this period. All patients received ultrasound and X⁃ray examination after admission. Among them, 61 cases (73.5%)required surgical treatment, and 22 cases (26.5%) were successfully treated non ⁃ surgically. The occurrence rates of three imaging manifestations, including intestinal obstruction (ultrasound 24/61, radiography 32/61), ascites (ultrasound 27/61), and intestinal torsion (ultrasound 13/61), were higher in the surgical group than the non⁃surgical group (P < 0.05). The presence of pneumoperitoneum signs in the surgical group was also higher than the non⁃surgical group, but the number of cases was not enough to show statistical significance. There was no statistical difference in the proportion of multiple calcifications and meconium pseudocysts between two groups. Conclusion：Imaging findings that predicted the need for surgery were intestinal obstruction, ascites, volvulus and pneumoperitoneum. Neonates only with multiple calcifications in the peritoneum can be successfully treated non⁃operatively. Children with meconium pseudocyst do not need surgery if they do not have the above manifestations. [ABSTRACT FROM AUTHOR]

The incidence of giant cystic meconium peritonitis (GCMP) in pregnancies following artificial reproductive techniques is rare. We report the first case of GCMP following in vitro fertilization and embryo transfer in China. A 32-year-old woman with a history of bilateral salpingectomy due to ectopic pregnancy attended our in vitro fertilization and embryo transfer program. Meconium peritonitis, polyhydramnios, bowel dilatation, and intra-abdominal calcification were detected by ultrasound at 33 weeks of gestation. Cesarean section due to scarred uterus was performed at 35+1 weeks of gestation. A normal female infant with a distended abdomen was delivered. Emergency laparotomy was performed on the female infant because of the presence of a giant abdominal mass. A 0.2-cm perforation was found in the ileum. Enterostomy could not be performed due to the heavy adhesion. Prenatal diagnosis of meconium peritonitis is possible through careful ultrasonographic examination, and prognosis can be improved through early surgical intervention and intensive postoperative support.

Introduction: The cyst of the canal of Nuck, or female hydrocele, occurs due to incomplete closure of the peritoneal-vaginal canal during the antenatal period. During the fetal period, there may be perforation of the intestinal loops with meconium exiting into the abdominal cavity, reaching the peritoneal-vaginal duct, which is still patent. When in contact with the tunica vaginalis around the testicle in boys, the meconium produces an intense inflammatory reaction causing a condition known as meconium orchitis. The corresponding condition in girls is extremely rare, with only two cases having been published so far. Case report: Female infant, 45 days old, presented with an acute condition of hard, painful right inguinal tumor, without other abdominal or intestinal manifestations. She underwent emergency surgery with the hypothesis of an incarcerated inguinal hernia and the intraoperative finding was a rounded tumor with meconium material and an intense inflammatory process in the right inguinal region. When performing inguinal exploration on the left side, material similar to meconium was also found inside the hernial sac, but with a milder inflammatory process. It evolved uneventfully in the postoperative period. Abdominal X-ray performed during outpatient follow-up showed gross and diffuse calcifications in the abdominal cavity. Conclusion: Meconium orchitis, caused by the presence of meconium around the tunica vaginalis in boys, can also occur in girls, manifesting as a cyst of the canal of Nuck with meconium-induced inflammation. Incarcerated inguinal hernia is the main differential diagnosis of this condition and surgical correction should be performed by inguinotomy if there is no associated abdominal manifestation.

This study aimed to evaluate the safety and effectiveness of circumumbilical incision (CUI) for neonates requiring intestinal anastomosis. Seventy neonates requiring intestinal anastomosis at our institution between 2003 and 2020 were included in this retrospective case-control study. Patients were classified into the CUI (25 patients: 36%) and transverse incision (TI) groups (45 patients: 64%). Postoperative complications and surgical outcomes were compared between the two groups. Intestinal perforation at the non-anastomotic site occurred significantly more often in the CUI group than in the TI group (3 patients: 12%, and 0 patients: 0%, respectively (p = 0.042)). There were no between-group differences regarding anastomotic leakages, anastomotic strictures, time to enteral feeding, operative time, and blood loss. Neonatal intestinal surgery employing CUI might be associated with increased intestinal perforation at the non-anastomotic site. Hesitating to enlarge the skin incision to maintain favorable cosmetic outcomes might cause severe injury to the delicate neonatal intestine during the surgical procedure owing to the restricted surgical field. When performing CUI, we suggest that the skin incision should be extended without hesitation whenever there is difficulty in manipulating the intestine. [ABSTRACT FROM AUTHOR]

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.

We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental enterectomy with end‐to‐end anastomosis was performed. This case report highlights the diagnosis complexity of a fetal intestinal atresia associated with cystic fibrosis. [ABSTRACT FROM AUTHOR]

What is currently known about this topic: - In the past, meconium peritonitis (MP) had a grave prognosis with high morbidities and mortalities. With the advancement in pediatric anesthesia, intensive care and surgical techniques, the mortality of MP has much decreased. MP is no longer considered a lethal disease. What new information is contained in this article: - Our study included 35 patients with MP and is relatively large-scaled when compared with the past literature. The effective multi-disciplinary antenatal counselling in our center facilitated the perinatal management of MP. 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 [ABSTRACT FROM AUTHOR]

Abstract We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental enterectomy with end‐to‐end anastomosis was performed. This case report highlights the diagnosis complexity of a fetal intestinal atresia associated with cystic fibrosis.

Meconium peritonitis (MP) presenting as hydrops is a rare entity. A 34-week hydropic infant was born to mother diagnosed with a case of nonimmune hydrops. Postnatally, the neonate was diagnosed as a case of MP based on clinical examination and investigations. The neonate underwent exploratory laparotomy which revealed diffuse MP with ileal perforation. She underwent resection of ileal perforation with ileocolic anastomosis. The index case highlights the importance of thorough clinical examination and abdominal X-ray in the diagnosis of MP.

Meconium peritonitis (MP) combined with intestinal atresia (IA) is a rare neonatal condition, and it is even rarer in combination with biliary atresia (BA). We describe a case of an infant who developed short bowel syndrome after partial intestinal resection due to MP and IA, along with a Santullienterostomy. During continuous enteral and parenteral nutrition, the stool color became paler. BA was identified by elevated direct bilirubin (DBIL), gamma-glutamyltransferase (GGT), serum matrix metalloproteinase-7 (MMP-7), and hepatobiliary ultrasound; then, Kasai portoenterostomy (KPE) was performed promptly. The Roux-en-Y limb was adjusted intraoperatively to preserve the maximum length of the small intestine while closing the enterostomy. After the operation, the infant gradually adapted to enteral nutrition, his bilirubin level returned to normal, and his weight gradually caught up to the normal range. Although rare, BA should be suspected when MP is combined with IA and when the stool becomes paler in color in the enterostomy state.

We reviewed the outcomes of meconium peritonitis and evaluated the safety and feasibility of primary radical surgery for meconium peritonitis. A total of 21 cases of meconium peritonitis between 2006 and 2020 were retrospectively reviewed. The patients were classified into two groups based on the type of surgery: group I (primary radical surgery, n = 16) and group II (multistage surgery; drainage only or ileostomy, followed by elective surgery, n = 5). Patient backgrounds and surgical outcomes were compared between the two groups. The term of prenatal diagnosis, preoperative white blood cell count, and preoperative catecholamine use were not significantly different between the two groups. Group I included more mature neonates than group II (gestational age at birth, 35w1d vs 30w1d, p = 0.02; birth weight, 2.5 kg vs 1.1 kg, p < 0.01). Preoperative C-reactive protein was significantly lower in group I (0.37 mg/dL vs 2.8 mg/dL, p < 0.05). Operation time, blood loss, time to enteral feeding, and complication rates were not significantly different between the two groups. The surgical outcomes of primary radical surgery were comparable to those of multistage surgery, although the patients' backgrounds were different. Our strategy of selecting one-stage or multiple-stage surgery for treatment of meconium peritonitis, depending on the patient's general condition and degree of intestinal ischemia, was reasonable. [ABSTRACT FROM AUTHOR]

Objective: This study explored the characteristics of fetal mesenteric blood flow perfusion across various gestational weeks and evaluated the efficacy of Microvascular Flow (MV-Flow) imaging technology in assessing intestinal wall blood flow in fetuses with meconium peritonitis (MP)., Method: In this retrospective study, we analyzed 35 fetuses with MP and 160 healthy fetuses. We examined the correlation between the Vascular Index (VI) of mesenteric perfusion and gestational age, conducted an analysis comparing MP operative and non-operative groups, and developed a predictive model for surgical intervention., Results: The VI value demonstrated no significant change with increasing gestational age (correlation coefficient = 0.005, p  = 0.946). For healthy fetuses, VI ranged approximately from 34.66% to 67.26% using the automatic ellipse method. The MP operative group exhibited significantly more cesarean deliveries (100% vs. 52.9%, p  = 0.003), shorter gestational periods (34.76 ± 2.16 weeks vs. 37.48 ± 1.55 weeks, p  < 0.001), lower birth weights (2762.14 ± 452.76 g vs. 3225.88 ± 339.98 g, p  = 0.003), more persistent ascites (92.9% vs. 52.9%, p  = 0.021), more frequent intestinal wall echo reductions (57.1% vs. 5.9%, p  = 0.004), and lower VI (18.57 ± 5.51% vs. 39.41 ± 7.02%, p  < 0.001). A predictive model was established: Logit (P)=8.86 - (0.37* VI) + (1.49* ascites), yielding an area under the curve of 0.857, with 78.6% sensitivity and 88.2% specificity. The VI value was significantly associated with the need for postnatal surgery (OR = 0.689, 95% confidence interval: 0.511 - 0.929, p  = 0.015). A Receiver Operating Characteristic curve analysis for VI in predicting postnatal surgery showed an area under the curve of 0.971, with an optimal cutoff value of 35%, achieving 91% sensitivity and 94.4% specificity., Conclusion: MV-Flow imaging effectively quantified fetal bowel wall blood flow perfusion. There was no significant change in VI across different gestational weeks. Significantly lower VI values in MP fetuses indicated an increased risk of intestinal wall necrosis and the potential need for postnatal surgical intervention.

Background: The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP., Methods: The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed., Results: The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference ( p  > .05) in the occurrence of various prenatal ultrasound findings by etiology., Conclusion: Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.

Abstract Background Meconium peritonitis (MP) is a rare fetal disease that needs to be urgently identified for surgical intervention. We report a series of 35 patients diagnosed prenatally with MP by magnetic resonance imaging (MRI), illustrate the imaging findings and investigate the predictive value of these findings for postpartum management. Method A consecutive cohort of patients diagnosed with MP who were born at our institution from 2013 to 2018 was enrolled retrospectively. The prenatal ultrasound and MRI findings were analyzed. Fisher’s exact probability test was used to evaluate the predictive value of MRI for surgical intervention between the operative group and the nonoperative group. Results Ascites (30/35) and distended bowel loops (27/35) were two of the most common prenatal MP-related findings on fetal MRI. Of the 35 infants, 26 received surgical intervention. All fetuses with MRI scans showing bowel dilatation (14/26, p = 0.048) and micro-colorectum (13/26, p = 0.013) required surgery. There were no significant differences in the number of fetuses with meconium pseudocysts and peritoneal calcifications between the two groups. Conclusion Fetuses with bowel dilatation and micro-colorectum on MRI may need postpartum surgical intervention. Infants with only a small amount of ascites and slight bowel distention were likely to receive conservative treatment.

Abstract Background Meconium peritonitis is defined as aseptic chemical inflammation caused by intrauterine bowel perforation. The underlying causes of bowel perforation include intestinal atresia, midgut volvulus, intussusception, congenital bands, and meconium ileus. Case presentation Siblings with prenatally diagnosed meconium peritonitis of different etiologies were found. The elder sister was born at 36 + 6 weeks gestation with a birth weight of 3110 g. She was diagnosed with meconium peritonitis caused by ileal atresia. Two years later, the younger brother was born at 34 + 3 weeks gestation with a birth weight of 2850 g. He was diagnosed with meconium peritonitis caused by midgut volvulus. Conclusions Among the previously reported cases of meconium peritonitis, familial occurance of meconium peritonitis is extremely rare. We present a case of prenatally diagnosed meconium peritonitis in siblings to promote further understanding of its etiology and clinical course.

Abstract Background In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs, such as pseudocysts, can. be detected during the fetal period so that more patients can be diagnosed prenatally and receive surgery. in the early stage of life. The survival rate of MP has increased up to 80% in recent years. According to. a review of the treatment and outcomes of patients diagnosed with MP, we evaluated the influence of. early operation on survival rate and discussed the risk factors of prognosis. Methods We collected 79 cases of patients diagnosed with MP who were treated in our department. from October 2001 to December 2017. They were divided into 2 groups. Patients in group A were born. in our hospital. Patients in group B were born in a local hospital with suspicion of MP and then transferred. to our department. Results The birth weight (BW) and gestational age (GA) of patients were higher in group A than in. group B. There was no significant difference in the proportion of premature and low birth weight (LBW). patients between the two groups (p = 0.422, p = 0.970). Their age at the time of surgery was younger in. group A than in group B (1.4 ± 2.0 vs. 6.9 ± 14.9, p

Intrauterine appendicular perforation leading to meconium peritonitis is exceptionally rare, with few reported cases in the literature. This case underscores the diagnostic challenges and high mortality associated with neonatal appendicular perforation. Neonatal appendicitis and subsequent perforation are uncommon due to the funnel shape of the fetal appendix, which reduces susceptibility to luminal obstruction. While advances in neonatal care and diagnostic modalities have improved outcomes, challenges persist in timely diagnosis and management. We present the case of a preterm infant, one of dichorionic-diamniotic (DCDA) twins delivered via cesarean section, who developed gross abdominal distension and respiratory distress shortly after birth. Diagnostic abdominocentesis revealed meconium-stained fluid, prompting further investigation with imaging and subsequent exploratory laparotomy. Extensive adhesions and cecal perforation were observed, necessitating a cecostomy. Despite interventions, the infant's condition deteriorated, leading to a fatal outcome. Intrauterine appendicular perforation leading to meconium peritonitis is a rare and difficult-to-diagnose condition. Antenatal suspicion and early surgical intervention are crucial for improving outcomes. Factors contributing to neonatal appendicular perforation include ischemia, obstruction, and infective etiologies. Neonatal appendicular perforation is a rare but life-threatening condition requiring a high index of suspicion for prompt diagnosis and management. Advances in diagnostic tools and antenatal monitoring have contributed to improved outcomes, highlighting the importance of considering this diagnosis in cases of unexplained neonatal abdominal distension., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Singh et al.)

Acute abdomen in the fetus can present as nonspecific fetal distress, and occasionally necessitate emergency cesarean section for the mother and subsequent emergency neonatal surgery. Often, preoperative diagnosis in utero is challenging. The authors herein report two cases, a case of primary segmental antenatal intestinal volvulus resulting in the mother presenting at 35 wk with symptoms and decreased fetal movements, and another case of a rapidly distending fetal abdominal mass at 31 wk manifesting as fetal hydrops. The postdelivery newborn management issues are presented. Early identification by the maternal and neonatal team allows for early neonatal surgery and can reduce morbidity and mortality. This can be facilitated by advanced maternal and child health services and efficient patient transport systems. [ABSTRACT FROM AUTHOR]

Meconium peritonitis (MP) presenting as hydrops is a rare entity. A 34-week hydropic infant was born to mother diagnosed with a case of nonimmune hydrops. Postnatally, the neonate was diagnosed as a case of MP based on clinical examination and investigations. The neonate underwent exploratory laparotomy which revealed diffuse MP with ileal perforation. She underwent resection of ileal perforation with ileocolic anastomosis. The index case highlights the importance of thorough clinical examination and abdominal X-ray in the diagnosis of MP. [ABSTRACT FROM AUTHOR]

Meconium peritonitis is a rare fetal disease due to the perforation of bowel in utero and sterile inflammatory reaction related to the extravasation of the meconium. Various classification systems have been published in the literature, and better outcomes have been seen in recent years with a survival rate of more than 90%. The prognosis of meconium peritonitis is more favorable when detected in utero rather than when the neonatal diagnosis is made. Prenatal findings of meconium peritonitis in our case are meconium pseudocyst, polyhydramnios, and peritoneal calcifications. Although it was perceived as complex meconium peritonitis and was expected to require surgery in the postnatal period, it was managed conservatively. Probably, it did not need to undergo surgery because the perforation had occurred in mid-trimester and enough time has elapsed in the utero life to seal the perforation site and to decrease the size of the meconium pseudocyst. We cited a rare case of meconium peritonitis with a meconium pseudocyst in a fetus, which was managed conservatively and resolved spontaneously in the postnatal period.

Abstract Background Meconium peritonitis is an infrequent congenital disease usually caused by perforation of the fetal digestive tract. Meconium peritonitis resulting from intrauterine appendiceal perforation has been rarely reported and is often overlooked during pregnancy. We herein report two cases of fetal appendiceal perforation. Case presentation Two neonates were found to have intestinal distension and gradually increasing ascites antenatally. After birth, diagnostic abdominal punctures revealed meconium peritonitis. Urgent surgery showed both neonates had developed gangrenous appendicitis in utero. Pathological examination supported the diagnosis of fetal appendiceal perforation in both neonates, and one also had deformity of cecal duplication. In the present report, we also review the presentation, diagnosis, pathology, management, and recent literature of fetal appendiceal perforation. Conclusion Meconium peritonitis due to fetal appendiceal perforation is extremely rare, and preoperative diagnosis is almost impossible. However, clinicians should be aware of abnormal gastrointestinal manifestations in the fetus during the antenatal examination. For neonates with severe meconium peritonitis, an early operation with careful intraoperative exploration is necessary.

Background: Meconium peritonitis (MP) is a rare fetal disease that needs to be urgently identified for surgical intervention. We report a series of 35 patients diagnosed prenatally with MP by magnetic resonance imaging (MRI), illustrate the imaging findings and investigate the predictive value of these findings for postpartum management. Method: A consecutive cohort of patients diagnosed with MP who were born at our institution from 2013 to 2018 was enrolled retrospectively. The prenatal ultrasound and MRI findings were analyzed. Fisher's exact probability test was used to evaluate the predictive value of MRI for surgical intervention between the operative group and the nonoperative group. Results: Ascites (30/35) and distended bowel loops (27/35) were two of the most common prenatal MP-related findings on fetal MRI. Of the 35 infants, 26 received surgical intervention. All fetuses with MRI scans showing bowel dilatation (14/26, p = 0.048) and micro-colorectum (13/26, p = 0.013) required surgery. There were no significant differences in the number of fetuses with meconium pseudocysts and peritoneal calcifications between the two groups. Conclusion: Fetuses with bowel dilatation and micro-colorectum on MRI may need postpartum surgical intervention. Infants with only a small amount of ascites and slight bowel distention were likely to receive conservative treatment. [ABSTRACT FROM AUTHOR]

ObjectiTe To analyze the clinical features of meconium peritonitis (MP) and the related factors influencing its prognosis. Methods. four patients with MP who received auigical intervention at department of pedialiic intensive care unit, Xinhua Hospital, Shanghai Jiao Tbng University School of Medicine from May 2006 to May 2018 were Mrospectively reviewed, and divided into complication groxtp (rt=24) and non-camplication group (o=30). Risk factors of the two after operation were analyzed, including gecbsral condition，prenatal diagnosis and preoperative value of C-reactive protein (CRP), independfint.samples f tea test or Fisher's exact test Results. Compared with the non-cosqdication group, days of admission and operation after birth were longer; the gestational age and the birth weight were lower (all P<0.05) in the conlication group； the CRP value of the conlication group was higher than that of the non-complication group The prenatal diagnosis percentage of the non-complication group waa higher than that of the conlication group (#M).O39). However, there was no statistical significance in gender, Apgar score, surgical procedure, delivery type and preoatal ultrasound findings. Conclnslim Preoatal ultrasound detection with MP and early surgical treatment can improve the prognosis，and the preoperative inflammation level has a certain predictive value for the piognosia of children. [ABSTRACT FROM AUTHOR]

Background: Meconium peritonitis is defined as aseptic chemical inflammation caused by intrauterine bowel perforation. The underlying causes of bowel perforation include intestinal atresia, midgut volvulus, intussusception, congenital bands, and meconium ileus.Case Presentation: Siblings with prenatally diagnosed meconium peritonitis of different etiologies were found. The elder sister was born at 36 + 6 weeks gestation with a birth weight of 3110 g. She was diagnosed with meconium peritonitis caused by ileal atresia. Two years later, the younger brother was born at 34 + 3 weeks gestation with a birth weight of 2850 g. He was diagnosed with meconium peritonitis caused by midgut volvulus.Conclusions: Among the previously reported cases of meconium peritonitis, familial occurance of meconium peritonitis is extremely rare. We present a case of prenatally diagnosed meconium peritonitis in siblings to promote further understanding of its etiology and clinical course. [ABSTRACT FROM AUTHOR]

Background: Meconium peritonitis (MP) is an infrequent prenatal complication. Association between MP and pulmonary hypoplasia has never been reported. Case Report: A female infant with antenatally diagnosed MP and ascites was delivered at 36 gestational weeks. She died shortly after birth due to pulmonary insufficiency. Autopsy confirmed the presence of MP and ascites, and additionally revealed intestinal malrotation, volvulus, necrosis and perforation, and pulmonary hypoplasia. Congenital cytomegalovirus (CMV) infection was also noted. This was an unexpected finding as the mother was tested negative for CMV IgM at 26 gestational weeks after sonographic detection of fetal ascites. Conclusions: This is the first reported case of lethal pulmonary hypoplasia in a neonate with MP-associated ascites complicated by congenital CMV infection. This case illustrates that a negative maternal CMV IgM might not be sufficient to rule out congenital CMV, and that a concomitant infectious etiology should always be considered even when a primary cause for fetal ascites (e.g., MP in this case) is identified. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infantile fibrosarcoma (IFS) is a rare nonrhabdomyosarcoma soft tissue tumor and accounts for less than 1% of childhood cancers. Forty per cent are present at birth and only 10% of IFS occurs in the abdomen. Our case of neonatal fibrosarcoma presented as a distal small bowel stenosis complicated with meconium peritonitis. The diagnosis was by histology of the surgical resection. The diagnosis of IFS is challenging as there are no specific features of IFS on imaging. Any unexpected solid lesion should raise the suspicion of complicated bowel tumoral lesion. If a neoplastic lesion is suspected extensive, surgery may be postponed until the final diagnosis is made.

The greater omentum is an apron-like peritoneal mesothelial sheet that was described by ultrasound as a floating fluid-filled viscus in ascites during the fetal period. To examine the association between the etiology of fetal ascites and ultrasound findings of the greater omentum, a retrospective study was conducted. Ultrasound findings of fetal omentum were defined as follows: (1) a cyst-like shape with a thin membrane observed as wavy in the ascites, (2) beside the stomach and below the liver, and (3) no blood flow noted on color Doppler. Eleven pregnancies had fetal ascites. A fetal greater omentum was confirmed in eight cases in which ascites were caused by non-peritonitis: fetal hydrops (n = 4), congenital cytomegalovirus infection (n = 2), idiopathic chylous ascites (n = 1), and unknown cause (n = 1). Of these eight cases, no abdominal surgical management was required in three live babies. However, a fetal greater omentum was not confirmed in all three cases of meconium peritonitis. It was suggested that the finding of the greater omentum can be an important clue for estimating the pathophysiological etiology of fetal ascites and helping with postnatal management. It should be reasonable to add the finding of the greater omentum to the detailed ultrasound examination checklist.

The purpose of this study is to examine the outcome of transumbilical minilaparotomy for infants and compare the results between normal birthweight (NBW) and low birthweight (LBW). Between July 2010 and March 2017, infants who underwent abdominal surgery through transumbilical minilaparotomy were enrolled. Medical records were retrospectively reviewed. Patients were divided into two groups, NBW and LBW. Complexity was defined as complicated conditions other than intestinal atresia and malrotation. Totally, 16 patients were included. The diagnosis included intestinal atresia (n = 3), meconium peritonitis (n = 4), bowel infarction/necrosis (n = 4), spontaneous intestinal perforation (n = 2), segmental volvulus and necrosis (n = 1), necrotizing enterocolitis (n = 1), and malrotation (n = 1). The median gestational age and body weight were 32 (24–40) weeks and 1731 (560–4200) grams respectively. The median age at operation was 3 (1–41) days. The surgical procedure included primary repair of the intestine (n = 14), ileostomy (n = 1) and Ladd's procedure (n = 1). Postoperative complications included anastomotic leakage (n = 2), adhesion ileus (n = 1), and missed rectal atresia (n = 1). There was one mortality due to extremely low birthweight and poor lung maturation. Re-operation was required in 3 patients for anastomotic leakage (n = 2) and missed rectal atresia (n = 1). Mean birthweight was 2932 ± 97 and 1263 ± 667 g in NBW (n = 5) and LBW (n = 11), respectively (p < 0.01). Complexity rate was 40% and 90.9%, respectively (p = 0.034). The mean operation time was 139.4 ± 65.8 and 124.3 ± 46.1 min, respectively (p = 0.60). The complicated rate and reoperation rate were similar. Transumbilical minilaparotomy is technically feasible and an alternative option of minimally invasive surgery for LBW infants and complex conditions. [ABSTRACT FROM AUTHOR]

Fetal intestinal volvulus is a rare life-threatening condition with variable degrees of gravity and survival. In this article we are presenting a review of pathogenesis and current diagnosis of fetal volvulus, starting from the case of a preterm newborn with ascites who was incidentally diagnosed by ultrasound at the Emergency Department of Bucharest University Emergency Hospital, when a 35-week-pregnant patient arrived for uterine contractions and vaginal bleeding. The infant was born subsequently via urgent caesarean and underwent emergency exploratory laparotomy with small bowel resection. Late pregnancy manifestations of fetal pathologies contribute to a high rate of morbidity and mortality, and because of that we recommend that the third-trimester ultrasound performed between 32 and 34 weeks of amenorrhea should be routinely done, including a thorough assessment of all the organs, including the fetal bowel. [ABSTRACT FROM AUTHOR]

Background: The role of imaging in meconium peritonitis is not limited to establishing a diagnosis; rather, it might also be helpful in determining which neonates require surgery. However, few data in the literature correlate the postnatal radiographic and sonographic findings with the need for surgery.Objective: To compare the role of postnatal radiographic and sonographic findings in predicting the need for surgery in neonates with meconium peritonitis.Materials and Methods: We conducted a retrospective analysis of clinical, imaging and surgical findings in all neonates with meconium peritonitis in the period 1999-2014. We divided the children into operative or non-operative groups and then correlated each group with the presence or absence of the following findings on both the radiographs and sonograms: peritoneal calcification, meconium pseudocyst, intestinal obstruction, volvulus, ascites and pneumoperitoneum.Results: Thirty-seven neonates (22 males, 15 females) had meconium peritonitis in this period, of whom 23 (62%) required surgery and 14 (38%) were successfully treated non-surgically. None had an antenatal infection and three had cystic fibrosis (8%). Bowel obstruction identified on radiography (12/23, P=0.01) and sonography (9/23, P=0.04) and ascites identified with sonography (7/23, P=0.01) were associated with the need for surgical intervention. The presence of pneumoperitoneum and volvulus were also associated with surgical intervention. There was no significant statistical difference in the number of neonates with diffuse peritoneal calcification who were treated operatively or non-operatively. Four (33%) of the 12 neonates with meconium pseudocysts were successfully treated non-operatively.Conclusion: Imaging findings that predicted the need for surgery were intestinal obstruction, ascites, volvulus and pneumoperitoneum. Neonates with meconium pseudocysts did not require surgery if they were not associated with the described findings. The findings in our patients also indicate that those with diffuse peritoneal calcification as an isolated finding can be successfully treated non-operatively. [ABSTRACT FROM AUTHOR]

Meconium peritonitis (MP) is a rare etiology for nonimmune hydrops fetalis. We report a neonate delivered at 32 weeks' gestation in the context of antenatally diagnosed hydrops fetalis and first-trimester screening at high risk for Trisomy 21. The postnatal abdominal radiograph was striking for gross ascites, the paucity of bowel gas, and widespread calcifications, suggestive of MP and chromosomal analysis confirmed Trisomy 21. Exploratory laparotomy performed on day 3 of life revealed a large pseudocyst, ileal atresia with ileal perforation. MP masquerading as nonimmune hydrops fetalis in Trisomy 21 with ileal atresia is an extremely rare presentation, seldom reported in the literature. [ABSTRACT FROM AUTHOR]

Meconium peritonitis is a sterile chemical peritonitis caused by intestinal perforation in-utero or shortly after birth and perforation usually occurs due to intrauterine obstruction. Its incidence is approximately 1 in 35,000 births and the mortality was reported to be 60-80%. The radiographic findings of meconium peritonitis are pneumoperitoneum, intestinal obstruction and abdominal calcifications. The classic eggshell calcification occurs owing to the defensive mechanism of the body against the inflammation in an effort to surround the meconium in the abdominal cavity. In a newborn with abdominal distension, meconium peritonitis should be kept in mind, especially if calcified foci are seen on plain abdominal radiographs, since timely diagnosis and surgery improves the survival rates. We present the case of a female newborn of 34 weeks' gestational age was admitted to the neonatal intensive care unit (NICU) with marked abdominal distension. The pregnancy was complicated by maternal polyhydramnios and a cesarean section was performed due to fetal distress. The infant was noted to have a grossly distended abdomen; however, the physical examination was otherwise unremarkable. The abdominal radiograph revealed distension of the bowel loops and free air with multiple peritoneal calcifications (Figure 1). Surgery, performed on day 1 of life, demonstrated ileal atresia and perforation in the distal part of the ileum. Solid meconium, which leaked into the abdominal cavity was removed and the atresic bowel was resected and anastomosed. The infant regained bowel function on postoperative day 7 and discharged home on the third week after gradual advancement to full enteral feeding.

Fetal meconium peritonitis (MP) is a rare occurrence. Neonate that survives this rare condition is likely to form a meconium pseudocyst. Hereby, we present a case of a 33-year-old pregnant woman that presented with premature rupture of membranes at 34 weeks of gestation. Antenatal ultrasonography at 33 weeks revealed abnormal dilated bowel within the viable fetus. An emergency Cesarean section was performed and a baby boy was delivered at 34 weeks. Physical examination of the baby at birth revealed a palpable central abdominal mass. Lower gastrointestinal contrast imaging revealed a non-opacified dilated proximal small bowel and opacified collapsed distal small bowels and colon. A laparotomy was carried out and revealed MP with pseudocyst formation due to a midgut volvulus. Interestingly, meconium contamination was confined due to associated atretic small bowel which occurred secondary to the volvulus.

The cyst of the canal of Nuck, or female hydrocele, occurs due to incomplete closure of the peritoneal-vaginal canal during the antenatal period. During the fetal period, there may be perforation of the intestinal loops with meconium exiting into the abdominal cavity, reaching the peritoneal-vaginal duct, which is still patent. When in contact with the tunica vaginalis around the testicle in boys, the meconium produces an intense inflammatory reaction causing a condition known as meconium orchitis. The corresponding condition in girls is extremely rare, with only two cases having been published so far. Female infant, 45 days old, presented with an acute condition of hard, painful right inguinal tumor, without other abdominal or intestinal manifestations. She underwent emergency surgery with the hypothesis of an incarcerated inguinal hernia and the intraoperative finding was a rounded tumor with meconium material and an intense inflammatory process in the right inguinal region. When performing inguinal exploration on the left side, material similar to meconium was also found inside the hernial sac, but with a milder inflammatory process. It evolved uneventfully in the postoperative period. Abdominal X-ray performed during outpatient follow-up showed gross and diffuse calcifications in the abdominal cavity. Meconium orchitis, caused by the presence of meconium around the tunica vaginalis in boys, can also occur in girls, manifesting as a cyst of the canal of Nuck with meconium-induced inflammation. Incarcerated inguinal hernia is the main differential diagnosis of this condition and surgical correction should be performed by inguinotomy if there is no associated abdominal manifestation. [ABSTRACT FROM AUTHOR]