Meconium peritonitis and pseudo‐cyst formation: prenatal diagnosis and post‐natal course

Eckoldt, F.; Heling, K. S.; Woderich, R.; Kraft, Stephan; Bollmann, Rainer; Mau, Hans

doi:10.1002/pd.720

Cited by 67 publications

(38 citation statements)

References 23 publications

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“…15,16 In fact in a particular case some authors actually observed the leakage of meconium in the fetus during an ultrasound examination. 16 Prenatal diagnosis will facilitate perinatal management by allowing for surgery as soon as possible after birth following resuscitation, 17,18 thus avoiding the bacterial colonization that occurs after birth. This has led to reduction of operative mortality to about 2.4 to 23 per cent, 4,12,[16][17][18] when compared with the high rates in the early 1950s.…”

Section: Resultsmentioning

confidence: 99%

“…16 Prenatal diagnosis will facilitate perinatal management by allowing for surgery as soon as possible after birth following resuscitation, 17,18 thus avoiding the bacterial colonization that occurs after birth. This has led to reduction of operative mortality to about 2.4 to 23 per cent, 4,12,[16][17][18] when compared with the high rates in the early 1950s. 4 Only half of our patients had a supervised antenatal care with an ultrasound examination.…”

Section: Resultsmentioning

confidence: 99%

“…4,17 However, in our setting where facilities for neonatal intensive care and total parenteral nutrition are lacking and most patients come from poor backgrounds, multiple surgical operations within a short time span can be quite challenging.…”

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confidence: 99%

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Meconium peritonitis in Nigerian Children

et al. 2008

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Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal Xrays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Meconium peritonitis in Nigerian Children

et al. 2008

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“…The underlying etiology of the meconium peritonitis can be variable with many cases being idiopathic in nature. The typical location for the perforation associated with meconium peritonitis is in the distal ileum and cecum, where bowel obstruction tends to occur from the inspissated meconium [2,3]. Colonic perforations in the fetal or early neonatal period are rare [2], and have been associated with necrotizing enterocolitis, non-steroidal anti-inflammatory drugs (e.g., indomethacin), and Hirschsprung's disease.…”

Section: Introductionmentioning

confidence: 99%

Primary colonic congenital infantile fibrosarcoma presenting as meconium peritonitis

et al. 2008

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“…In the absence of radiological signs that characterise complex meconium peritonitis, the prognosis is very good [14,15]: in all other forms of prenatal meconium peritonitis, but the cystic form, emergency surgery is not required.…”

Section: Discussionmentioning

confidence: 98%

Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery

et al. 2008

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Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.

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Meconium peritonitis and pseudo‐cyst formation: prenatal diagnosis and post‐natal course

Cited by 67 publications

References 23 publications

Meconium peritonitis in Nigerian Children

Meconium peritonitis in Nigerian Children

Primary colonic congenital infantile fibrosarcoma presenting as meconium peritonitis

Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery

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