Can early surgery improve the outcome of patients with meconium peritonitis? A single-center experience over 16 years

Abstract

BackgroundIn 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.MethodsWe 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.ResultsThe 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 < 0.001). The overall survival rate of group A was higher. than that of group B (95.0% vs. 79.5%, p = 0.038). The prognosis of premature patients was worse than. that of full-term infants for both groups (p = 0.012).ConclusionsPrematurity is a significant risk factor related to death for MP patients. The survival rate. of MP patients can be improved by early operation during the neonatal period.

The importance of prenatal diagnosis for the surgical strategy of giant cystic meconium peritonitis: A case report

“…Advances in medical imaging technology result in an increased number of antenatal diagnoses of MP by fetus, including US [ 7 ], as in our case. Earlier diagnosis of MP by the antenatal US in our case has warned the neonatologist, obstetrician, and pediatric surgeon in our hospital to look for possible complications (such as bacterial peritonitis and septic shock), and prepared the surgical management for the patient since prenatal.…”

“…Early surgery effectively reduces intraabdominal and systemic inflammation, enhancing the outcomes of severely affected patients. Unfortunately, as of now, there is still no standardized operative procedure for MP [ 7 ]. We performed ileum resection with primary end-to-end anastomosis in our patient, which had a favorable outcome following this approach.…”

“…It has been suggested that a fetus diagnosed with MP should undergo early surgical treatment to increase the survival rate and prognosis of the patient [ 4 , 7 ]. However, the surgical approach option remains controversial: primary anastomosis or enterostomy depends on many factors [ 7 ]. We reported a giant cystic MP that was recognized using antenatal sonography (US).…”

Meconium Peritonitis: In Utero Diagnosis of a Rare Clinical Entity and Postnatal Outcome

“…If all the findings listed above are associated, the prognosis is bad and need for surgical intervention increases [9]. Uchida K, et al also verified that early surgery is an effective way to reduce intra-abdominal and systemic inflammation, which helps to enhance the outcome of severely affected patients [11].…”

Peritonitis meconial pseudoquística por atresia intestinal perforada. Reporte de un caso

“…En nuestra paciente se realizó una intervención exploratoria evacuatoria de la peritonitis, con lavado terapéutico de la cavidad en las primeras 24 horas de vida, lo que disminuyó el riesgo de sepsis y mortalidad, además se decide ostomizar para en una segunda intervención realizar resección intestinal no viable, se delimitaron bien los segmentos atrésicos, con una anastomosis termino-terminal de forma diferida.Dado que, la operación temprana se puede considerar un factor de importancia para mejorar el resultado de los pacientes con peritonitis por meconio, de igual forma se necesita de un diagnóstico temprano. La resonancia magnética (RM) proporciona información adicional útil sobre la distribución del meconio en el intestino delgado, lo que ayuda a aclarar el nivel de obstrucción10,11 . A pesar de los altos beneficios que puede brindar la RM en casos de Peritonitis meconial, en los países en vía de desarrollo (presente reporte de caso) su uso es limitado debido al alto costo del estudio.…”