Pediatrics & Neonatology
Volume 50, Issue 2 , Pages 59-64, April 2009

Clinical Manifestations in Infants with Symptomatic Meconium Peritonitis

  • Ming-Horng Tsai

      Affiliations

    • Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • Division of Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • College of Medicine, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Shih-Ming Chu

      Affiliations

    • Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • College of Medicine, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Reyin Lien

      Affiliations

    • Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • College of Medicine, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Hsuan-Rong Huang

      Affiliations

    • Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • College of Medicine, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Chih-Cheng Luo

      Affiliations

    • Division of Pediatric Surgery, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • College of Medicine, Chang Gung University, Taoyuan, Taiwan
    • Corresponding Author InformationCorresponding author. Division of Pediatric Surgery, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kwei-Shan, Taoyuan 333, Taiwan

Received 25 June 2008; received in revised form 12 August 2008; accepted 15 September 2008.

Article Outline

Background

Meconium peritonitis (MP) develops when bowel perforation occurs in utero or soon after birth, resulting in leakage of meconium into the peritoneal cavity. The clinical features are often variable and prenatal ultrasonography plays an important role in prenatal diagnosis.

Methods

We conducted a retrospective review of neonates diagnosed with MP in our hospital from January 1998 to December 2007. Prenatal examinations, postnatal presentations, investigations, management, patient outcomes, and possible causes were analyzed.

Results

Ten patients (five boys, five girls) diagnosed with MP were studied. The most common prenatal ultrasonographic finding was fetal ascites (7/10, 70%), followed by polyhydramnios (3/10, 30%), bowel dilatation (3/10, 30%), intra-abdominal calcification (1/10, 10%), and hydrops fetalis (1/10, 10%). Two of our patients were completely normal on prenatal ultrasonography. Only one MP diagnosis (1/10, 10%) was definitely confirmed by prenatal ultrasonography due to the presence of ascites, bowel perforation and intra-abdominal calcification. Nine patients (90%) required surgical intervention because of bowel perforation (5), bowel atresia (2), obstruction due to ileus (1), and intussusception (1). Peritonitis was of cystic type in one case (10%), fibroadhesive in five cases (50%), and generalized in four cases (40%). All 10 patients survived without long-term gastrointestinal complications.

Conclusion

Prenatal ultrasonography can be diagnostic for MP, which should be con sidered in the differential diagnosis of patients presenting with ascites or ab dominal distension at birth. Close observation of postnatal clinical manifestations and timely surgical intervention resulted in a high survival rate and favorable outcome in these patients at our hospital.

Key Words:  intra-abdominal calcification , meconium peritonitis , meconium pseudocyst , neonates

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PII: S1875-9572(09)60034-6

doi:10.1016/S1875-9572(09)60034-6

Pediatrics & Neonatology
Volume 50, Issue 2 , Pages 59-64, April 2009

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