Giant Cystic Meconium Peritonitis: A Rare Presentation of Co
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A 34-week preterm male neonate, with a birth weight 2.612 kg, born to a 27-y-old, 3rd gravida, antenatally showing polyhydramnios and fetal ascites was referred immediately after delivery for severe abdominal distention. Mother was diagnosed case of cervical tubercular lymphadenitis since 20 wk of current pregnancy, for which she was taking Antitubercular treatment (ATT) with good compliance. At birth baby was hemodynamically stable with gross abdominal distention.

X-ray erect abdomen was suggestive of pneumoperitoneum. Placenta was not available for examination as it was transferred ex-utero. Exploratory laparotomy was done, which showed giant cystic cavity with meconium peritonitis and terminal ileum perforation with adhesions. Terminal ileum, cystic cavity and proximal colon were excised in toto and end-to-end anastomosis performed.

Later feeds were initiated after 5 days and full feeds were established by day 10. Histopathological examination (HPE) of the specimen showed meconium peritonitis, serositis and reduplication cyst. There were no granulomas in HPE. The tissue specimen comprising of cyst wall was subjected to DNA based genetic testing for tuberculosis (TB) using GenoType MTBDRplus VER 2.0 kit.

The test showed positive result for Mycobacterium tuberculosis, sensitive to Rifampicin and Isoniazid. This test has sensitivity of 96.4% and specificity of 100%; however as with any DNA detection method, the DNA recovered may be from viable or non-viable bacteria. Baby was started on 4 drug ATT regimen (2HRZE/4HR) as per RNTCP guidelines. Baby was discharged successfully on day 14 of life. On follow-up baby is thriving well, weighing 6.520 kg at 5 months.