Meconium peritonitis : a case report
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Meconium peritonitis is defined as aseptic chemical inflammation caused by intrauterine bowel perforation. The underlying causes of bowel perforation include intestinal atresia, midgut volvulus, intussusception, congenital bands, and meconium ileus

A female baby was born at 36 + 6 weeks gestation by cesarean section. Her mother was a 30-year-old woman referred to hospital at 28 weeks of gestation due to fetal ascites and polyhydroamnios, which were suspicious for MP. The patient was the first baby of healthy parents. There was no family history of congenital anomalies. The patient had Apgar scores of 5 and 6 at 1 and 5 min, respectively. The body length was 45 cm (10–25 percentile) and head circumference was 34 cm (75–90 percentile).

After birth, the baby had respiratory difficulties. She was intubated and mechanically ventilated. She showed mild abdominal distension. A plain abdominal X-ray showed bulging flanks, an elevated diaphragm, and a calcified mass-like density in the left mid-abdomen. A laparotomy on the second day of life revealed a large amount of greenish peritoneal fluid with free meconium. A markedly dilated proximal segment ending blindly was found in the ileum 100 cm distal to the Treitz ligament and a perforation was found in the distal pouch corresponding to the calcification in the abdominal X-ray . They diagnosed her ileal atresia with perforation in the distal pouch. Affected proximal and distal pouches were resected, and a primary anastomosis was performed.

Her respiratory symptoms improved after the operation. She was extubated 1 day post-operatively. Feeding was started on postoperative day 7 and she showed gradual improvement. The remainder of her hospital course was uneventful, and she was discharged at 18 days of life. The patient’s karyotype was normal (46, XX). Laboratory studies were all normal. At her 3-year follow-up, patient condition was good with normal weight gain and development milestones.

In conclusion, among the previously reported cases of meconium peritonitis, familial occurrence of meconium peritonitis is extremely rare. This case of prenatally diagnosed meconium peritonitis to promote further understanding of its etiology and clinical course.

Source: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-2016-3
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