Meconium pseudocyst presenting as massive ascites in a new-b
Meconium pseudocyst (MPC) is a well-known condition that occurs secondary to bowel perforation taking place antenatally. Reported in the journal Radiology Case Reports, the authors describe a previously unpublished atypical presentation.

A 34-year-old woman was admitted at 32 + 5 weeks of gestation with a 2 day history of reduced fetal movement. She previously had a miscarriage at 6 weeks of gestation. She was otherwise in good health prior to and during this pregnancy. Antenatal scan at 32 + 1 weeks of gestation showed abnormal findings of polyhydramnios, foetal ascites along with hyper-echoic mass suggesting calcifications of unknown cause.

Estimated foetal weight on the scan was 2068 g (approximately 30th centile). She received 1 full course of steroids. Cardiotocographic examination showed pathologic tracing due to unprovoked decelerations and intermittent unprovoked bradycardia necessitating an emergency caesarian section.

A female infant weighing 1859 g (50th centile) was delivered. She was born in poor condition due to massive abdominal distension requiring therapeutic abdominal paracentesis (150-200 ml) to achieve effective lung volume and ventilation. She was initially given bag and mask ventilation and thereafter, intubated and mechanically ventilated. The Apgar scores were 4, 7, and 9 at 1, 5, and 10 minutes respectively.

The infant was then transferred to neonatal intensive care unit on synchronized intermittent mandatory ventilation for ongoing management. Abdominal ultrasound confirmed ascites but excluded vascular malformation. Urgent X-ray abdomen revealed ascites but absence of intra-abdominal calcifications noted antenatally.

This led to delay in diagnosis of MPC. Repeat abdominal ultrasound raised the possibility of a walled intra-abdominal abscess necessitating surgical review and intervention.

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Dr. M●●●●h S●●m
Dr. M●●●●h S●●m Paediatrics
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Nov 19, 2018Like