Prenatal Diagnosis of Cystic Meconium Peritonitis

Schwimer, S R; Vanley, Gregory T.; Reinke, Robert T.

doi:10.1002/jcu.1870120109

Cited by 14 publications

(3 citation statements)

References 10 publications

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“…Intestinal perforation has been described even in the absence of free air on abdominal X-ray and US evaluation. According to Schwimer [13] and Kuroda [2], 42.9% of cases submitted to CT and MRI in the postnatal period presented with no free air in the abdominal cavity on plain films. This condition is due to the presence of extended areas of dense intra-abdominal adhesions.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…A meconium cyst results from a perforation of the gut that has been walled off and surrounded by a calcific rim. [25][26][27][28] This diagnosis is unlikely in the case under discussion because of the absence of calcium in the cyst wall.…”

Section: Ifferential D Iagnosismentioning

confidence: 94%

Case 6-1995

Benacerraf¹,

Eichhorn²

1995

N Engl J Med

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A one-month-old girl was admitted to the hospital because of an intraabdominal mass.After a 42-week gestation, the infant had been delivered by cesarean section because of cephalopelvic disproportion. There were no complications during the pregnancy or delivery. A routine ultrasonographic examination ( Fig. 1), performed during the 28th week of pregnancy, showed a multiseptated cystic mass in the midabdomen. An ultrasonographic study during the 29th week of pregnancy showed the same mass slightly to the left of the midline. Another prenatal ultrasonographic examination at 30 weeks also showed the cystic abdominal mass near the midline. The infant weighed 3.76 kg at birth. She was fed a commercial formula with iron and was healthy from birth, although her parents described her as "colicky." Occasional constipation was noted; she did not vomit. Thirteen days before admission a computed tomographic (CT) scan of the abdomen (Fig. 2) revealed a cystic mass, 5 by 5 cm, that displaced the bowel to the left side and appeared to be unrelated to the genitourinary system or the liver. She was admitted to the hospital.The heart rate was 160, and the respirations were 24. The weight was 4.15 kg.On physical examination the infant appeared well. The head was normal, and the neck was supple. The lungs and heart were normal. The abdominal examination was normal; no organs or mass was felt. The external genitalia were normal, and rectal examination disclosed no pelvic or sacral mass. The neurologic examination was normal.The hematocrit was 34.9 percent, the white-cell count 13,200 per cubic millimeter, and the platelet count 505,000 per cubic millimeter. The mean corpuscular volume was 84 m m 3 .A diagnostic procedure was performed.

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“…Increased echogen icity in the fetal abdomen, as revealed by ultrasonogra phy, has been associated with several pathologic condi tions such as meconium peritonitis [1][2][3][4][5][6], meconium ileus [7,8], neoplasms and infections. However, several au thors [9][10][11] reported on increased intestinal echogenicity with subsequent normal neonatal outcome.…”

Section: Introductionmentioning

confidence: 99%

The Accuracy of the Assessment of Normal Fetal Intestinal Echogenicity – Electro-Optical Densitometry versus the Ultrasonographer’s Eye

Caspi¹,

Blickstein²,

Appelman

1992

Gynecol Obstet Invest

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Ten plates of normal fetal ultrasonography (at 16-20 weeks’ gestation) showing fluid, liver, lung, bone and intestine were submitted to electro-optical transmission surface densitometry. A distinct echogenic gradient has been found and used as an ‘internal standard’ to evaluate intestinal echogenicity. Intestine had significantly different echogenic properties from bone, liver and fluid but similar to that of lung. Using this echogenicity scale for fetal bowel, observers were correct in 46%, overscored in 32.6% and underscored in 21.4%. These poor results may be due to the significant inconsistency in the interpretation of each plate compared to other plates (about 65%). Although the densitometry-derived grading scale seems valid at these gestational ages, interobserver variation is too large and precludes a simple ultrasonic diagnosis of the hyperechogenic fetal intestine. Densitometric evaluation may be indicated in suspected cases when fetal bowel seems to have increased echogenicity.

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Prenatal Diagnosis of Cystic Meconium Peritonitis

Cited by 14 publications

References 10 publications

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

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

Case 6-1995

The Accuracy of the Assessment of Normal Fetal Intestinal Echogenicity – Electro-Optical Densitometry versus the Ultrasonographer’s Eye

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