Abstract
Meconium peritonitis (MP) is defined as an aseptic, localized or generalized peritonitis due to leakage of meconium into the peritoneal cavity due to perforation of the fetal intestine in utero. The incidence of MP is 1/30000. Even hypotheses related with ischemic events are most popular ones; neither of them has been substantiated yet. As first meconium reaches the ileum about 16th gestational week, timing of the event also determines the pathological types of MP, as fibro-adhesive, generalized, or cystic type. Intra-abdominal calcifications, being the most pathognomonic feature of the MP, are originated from the catalytic effect of fatty meconial compounds on the precipitation of calcium salts. A grading system described by Zangheri et al. can be used for international standardization of prenatal diagnosis. Antenatal diagnosis should also include investigation for congenital anatomical or structural anomalies, cystic fibrosis, and chromosomal abnormalities. When there is prenatal suspicion of MP in a patient, postnatal diagnosis is through abdominal and/or scrotal radiographs and ultrasonography. The natural history of prenatally diagnosed MP is different than diagnosed postnatally since some prenatally diagnosed cases resolve spontaneously. While there is not an established treatment modality in prenatal period, postnatal treatment varies depending on the signs and symptoms of the neonate.
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References
Agerty HA. A case of perforation of the ileum in newborn infant with operation and recovery. J Pediatr. 1943;22:233.
Alanbuki AH, Bandi A, Blackford N. Meconium periorchitis: a case report and literature review. Can Urol Assoc J. 2013;7(7–8):495–8.
Aydin E. Rapidly growing intraabdominal cyst in a newborn: intestinal duplication. APSP J Case Rep. 2016;7:18.
Aydin E, Emre S, Adaletli I, et al. Incidentally diagnosed adrenal calcification. J Turk Assoc Pediatr Surg. 2013;2-3:89–92.
Blumental DH, Rushovich AM, WiIliams RK, et al. Prenatal sonographic findings of meconium peritonitis with pathologic correlation. J Clin Ultrasound. 1982;10:350–2.
Boix-Ochoa J. Patologia quirurgica del meconio. Med Esp. 1982;81:30–51.
Bowen A, Mazer J, Zarabi M, et al. Cystic meconium peritonitis: ultrasonographic features. Pediatr Radiol. 1984;14:18–22.
Cassacia G, Trucchi A, Nahom A, et al. The impact of cystic fibrosis on neonatal intestinal obstruction: the need for prenatal/neonatal screening. Pediatr Surg Int. 2003;19:75–8.
Cerise EJ, Whitehead W. Meconium peritonitis. Am Surg. 1969;35:389.
Chan KL, Tang MH, Tse HY, et al. Meconium peritonitis: prenatal diagnosis, postnatal management and outcome. Prenat Diagn. 2005;25:676–82.
Cook PL. Calcified meconium in the newborn. Clin Radiol. 1978;29:541–6.
Degnan AJ, Bulas DI, Sze RW. Ileal atresia with meconium peritonitis: fetal MRI evaluation. J Radiol Case Rep. 2010;4(3):15–8. doi:10.3941/jrcr.v4i3.356.
Dirkes K, Crombleholme TM, Craigo SD, et al. The natural history of meconium peritonitis diagnosed in utero. J Pediatr Surg. 1995;30:979–82.
Dunne M, Haney P, Sun CCJ. Sonographic features of bowel perforation and calcific meconium peritonitis in utero. Pediatr Radiol. 1983;13:231–3.
Faripor F. Origin of calcification in healed meconium peritonitis. Med Hypotheses. 1984;14:51–6.
Fonkalstrud EW, Ellis DG, Clatworthy Jr HW. Neonatal peritonitis. J Pediatr Surg. 1966;1:227–39.
Garb M, Riseborough J. Meconium peritonitis presenting as fetal ascites on ultrasound. Br J Radiol. 1980;53:602–4.
Gugliantini P, Caione P, Rivosecchi M, et al. Intestinal perforation in newborn following intrauterine meconium peritonitis. Pediatr Radiol. 1979;8:113–5.
Gunn LC, Ghionzoli OG, Gardner HG. Healed meconium peritonitis presenting as a reducible scrotal mass. J Pediatr. 1978;92:847.
Heydenrych JJ, Marcus PB. Meconium granulomas of the tunica vaginalis. J Urol. 1976;115:596–8.
Izumi Y, Sato Y, Kakui K, et al. Prenatal treatment of meconium peritonitis with urinary trypsin inhibitor. Ultrasound Obstet Gynecol. 2011;37(3):366–8.
Kanamori Y, Terawaki K, Takayasu H, et al. Interleukin 6 and interleukin 8 play important roles in systemic inflammatory response syndrome of meconium peritonitis. Surg Today. 2012;42(5):431–4.
Kolawole TM, Bankole MA, Olurin EO, et al. Meconium peritonitis presenting as giant cysts in neonates. Br J Radiol. 1973;46:964–7.
Lally KP, Mehall JR, Xue H, et al. Meconium stimulate a pro-inflammatory response in peritoneal macrophages: for meconium peritonitis. J Pediatr Surg. 1999;34:214–7.
Lloyd JR. The etiology of gastrointestinal perforations in the newborn. J Pediatr Surg. 1969;3:77.
Lorimer WS, Ellis DG. Meconium peritonitis. Surgery. 1966;60:470–5.
Louw MB. Resection and end to end anastomosis in the management of atresia and stenosis of small bowel. Surgery. 1967;62:940.
Miller JP, Smith SD, Newman B, et al. Neonatal abdominal calcification: is it always meconium peritonitis? J Pediatr Surg. 1988;23:555–6.
Minato M, Tadao O, Hisayuki M, et al. Meconium pseudocyst with particular pathologic findings: a case report and review of the literature. J Pediatr Surg. 2012;47(4):e9–12. doi:10.1016/j.jpedsurg.2011.11.050.
Miyake H, Urushihara N, Fukumoto K, et al. Primary anastomosis for meconium peritonitis: first choice of treatment. J Pediatr Surg. 2011;46(12):2327–31.
Nam SH, Kim SC, Kim DY, et al. Experience with meconium peritonitis. J Pediatr Surg. 2007;42:1822–5.
Patton WL, Lutz AM, Willmann JK, et al. Systemic spread of meconium peritonitis. Pediatr Radiol. 1998;28:714–6.
Regev RH, Markovich O, Arnon S, et al. Meconium periorchitis: intrauterine diagnosis and neonatal outcome: case reports and review of the literature. J Perinatol. 2009;29(8):585–7.
Rickham PP. Peritonitis of the neonatal period. Arch Dis Child. 1955;30:23.
Rubin BK, Tomkiewicz RP, Patrinos ME, et al. The surface and transport properties of meconium and reconstituted meconium solutions. Pediatr Res. 1996;40:834–8.
Saleh N, Annegret G, Ulrich G, et al. Prenatal diagnosis and postnatal management of meconium peritonitis. J Perinat Med. 2009;37(5):535–8. doi:10.1515/JPM.2009.097.
Sciarrone A, Teruzzi E, Pertusio A, et al. Fetal midgut volvulus: report of eight cases. J Matern Fetal Neonatal Med. 2016;29(8):1322–7.
Shyu MK, Chen CD, Hsieh FJ, et al. Intrauterine intervention in a case of recurrent meconium peritonitis. Prenat Diagn. 1994;14:993–5.
Simpson JY. Peritonitis in the fetus in utero. Edinb Med Surg J. 1838;15:390.
Smith B, Clatworthy HW. Meconium peritonitis: prognostic significance. Pediatrics. 1961;27:967.
Taba R, Yamakawa M, Harada S, et al. A case of massive meconium peritonitis in utero successfully managed by planned cardiopulmonary resuscitation of the newborn. Adv Neonatal Care. 2010;10(6):307–10.
Tanaka K, Hashizume K, Kawarasaki H, et al. Elective surgery for cystic meconium peritonitis: report of two cases. J Pediatr Surg. 1993;28:960–1.
Tibboel D, Molenaar JC. Meconium peritonitis. A retrospective, prognostic analysis of 69 patients. Z Kinderchir. 1984;39:25–8.
Tibboel D, Gaillard JL, Molenaar JC. The ‘microscopic’ type of meconium peritonitis. Z Kinderchir. 1981;34:9–16.
Uchida K, Yuhki K, Kohei M, et al. Meconium peritonitis: prenatal diagnosis of a rare entity and postnatal management. Intractable Rare Dis Res. 2015;4(2):93–7. doi:10.5582/irdr.2015.01011.
Vilhena-Moraes R, Cappellano G, Mattosinho Franca LC, et al. Peritonite meconial. Rev Paul Med. 1964;65:231.
Wang CN, Chang SD, Chao AS, et al. Meconium peritonitis in utero – the value of prenatal diagnosis in determining neonatal outcome. Taiwan J Obstet Gynecol. 2008;47(4):391–6.
Zangheri G, Andreani M, Ciriello E, et al. Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery. Prenat Diagn. 2007;27:960–3.
Zerhouni S, Mayer C, Skarsgard ED. Can we select fetuses with intra-abdominal calcification for delivery in neonatal surgical centers? J Pediatr Surg. 2013;48(5):946–50.
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Peiró, J.L., Aydin, E. (2017). Meconium Peritonitis. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_72-1
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DOI: https://doi.org/10.1007/978-3-642-38482-0_72-1
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