Meconium peritonitis in utero

Abstract

To clarify the relationship between clinical features in utero and postnatal prognosis, 20 fetuses who underwent ultrasonic (US) evaluation for meconium peritonitis (MP) over a 17-year period were reviewed. According to final US findings in utero, patients were classified into three types. Type I (massive meconium ascites) was noted is 5 cases, type II (giant pseudocyst) in 4, and the other 11 were classified as type III (calcification and/or small pseudocyst). Abdominal calcifications were identified in only 5 cases (2 type I, 1 type II, 2 type III). Seven fetuses who had associated polyhydramnios (1 Type I, 1 Type II, 2 Type III) and fetal hydrops (3 Type II) were delivered before 36 weeks' gestation. Cardiopulmonary resuscitation at birth was required in 9 cases (5 type I, 4 type II) who underwent abdominal drainage before delivery and/or immediately after birth. Although dilatation of the intestine was identified in 10 fetuses (2 type II, 8 Type III), 18 had intestinal atresia and 2 had fecal obstruction of the distal ileum. Four infants (2 type I, 1 type II, 1 type III) died of respiratory failure and postoperative complications. These results indicated that careful fetal US may be useful for perinatal management of MP.

Correlation of Prenatal Ultrasound and Postnatal Outcome in Meconium Peritonitis

“…Another review in 1986 reported a mortality rate of 48% in meconium peritonitis [23]. However, better outcomes were reported in the recent literature with a survival rate of 84.6% [4] to 80% [15]. A similar result is shown in our study with a survival rate of 82.4% (14/17).…”

“…If the site is not sealed, cystic meconium peritonitis may form a meconium pseudocyst [5,8,10,11,13]. Kamata et al [15] also reported a change in ultrasound features from massive ascites to meconium pseudocyst and then to peritoneal calcification. Therefore, the final features at delivery may be useful for clinical evaluation.…”

“…Polyhydramnios is found in 25% [15] to 50% [4] of patients with meconium peritonitis. In our report, 53% (9/17) of patients were found to have polyhydramnios before birth.…”

“…Kamata [15] classified patients into three catego-ries: type I: massive ascites taking up nearly all of the free abdominal space; type II: giant pseudocyst and/or meconium ascites taking up more than half of the abdominal free space, and type III: peritoneal calcification and small meconium pseudocysts/ascites. Kamata found that cardiopulmonary resuscitation at birth was required in all patients with type I and II disease, all of whom also underwent abdominal drainage before delivery and/or immediately after birth.…”

“…Fetuses with meconium peritonitis can be diagnosed by prenatal ultrasound examination, and an increasing number of antenatal diagnoses are being reported [3][4][5][6][7][8][9][10][11][12][13][14]. However, only a few studies have scrutinized the relationship between the prenatal specific findings of meconium peritonitis and the postnatal outcome [4,7,8,15]. In cases of severe ascites with marked abdominal distension and diaphragm elevation, the benefits of fetal paracentesis in reducing the lung compression from profound ascites have also not been evaluated.…”