Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years

Objective: To identify the fetal and neonatal imaging characteristics of meconium peritonitis (MP) and their clinical outcome. We also studied the role of prenatal ultrasound (US) in antenatal diagnosis and its use in predicting the need for surgical intervention postnatally. Material and Methods: We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014. Results: Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range 19-31). Fetal ascites (93.3%) was the most common prenatal US finding. Of the 18 infants, 12 (66.7%) required surgical intervention. The overall survival rate was 94.4%. All infants with a prenatal US scan showing meconium pseudocyst or bowel dilatation required surgical intervention postnatally. Discussion: A combination of ascites, intraperitoneal calcification, and echogenic bowel on fetal US raises a high suspicion of MP. Surgical intervention is indicated in the presence of meconium pseudocyst on fetal or postnatal US scan. Antenatal US has high specificity (100%) but low sensitivity (22.2%) in detecting meconium pseudocyst. A favorable outcome can be expected with early antenatal diagnosis and timely surgical intervention in a tertiary hospital.

[1]  Raju Sharma,et al.  Role of MRI in fetal abdominal cystic masses detected on prenatal sonography , 2010, Archives of Gynecology and Obstetrics.

[2]  C. Luo,et al.  Clinical manifestations in infants with symptomatic meconium peritonitis. , 2009, Pediatrics and neonatology.

[3]  U. Gembruch,et al.  Prenatal diagnosis and postnatal management of meconium peritonitis , 2009, Journal of perinatal medicine.

[4]  A. Chao,et al.  Meconium peritonitis in utero---the value of prenatal diagnosis in determining neonatal outcome. , 2008, Taiwanese journal of obstetrics & gynecology.

[5]  H. Won,et al.  Experience with meconium peritonitis. , 2007, Journal of pediatric surgery.

[6]  P. Vergani,et al.  Fetal intra‐abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery , 2007, Prenatal diagnosis.

[7]  R. Tang,et al.  Meconium peritonitis: prenatal diagnosis, postnatal management and outcome , 2005, Prenatal diagnosis.

[8]  F. Hsieh,et al.  Meconium peritonitis presenting as isolated massive fetal ascites , 2004, Prenatal diagnosis.

[9]  E. Pan,et al.  Radiographic diagnosis of meconium peritonitis. A report of 200 cases including six fetal cases , 2004, Pediatric Radiology.

[10]  K. Heling,et al.  Meconium peritonitis and pseudo‐cyst formation: prenatal diagnosis and post‐natal course , 2003, Prenatal diagnosis.

[11]  S. Chow,et al.  Correlation of Prenatal Ultrasound and Postnatal Outcome in Meconium Peritonitis , 2003, Fetal Diagnosis and Therapy.

[12]  J. Tseng,et al.  Meconium peritonitis in utero: prenatal sonographic findings and clinical implications. , 2003, Journal of the Chinese Medical Association : JCMA.

[13]  ACOG Practice Bulletin No. 27: Clinical Management Guidelines for Obstetrician-Gynecologists. Prenatal diagnosis of fetal chromosomal abnormalities. , 2001, Obstetrics and gynecology.

[14]  S. Kamata,et al.  Meconium peritonitis in utero , 2000, Pediatric Surgery International.

[15]  M. Zerbini,et al.  Intra‐uterine parvovirus B19 infection and meconium peritonitis , 1998, Prenatal diagnosis.

[16]  R. Schild,et al.  Fetal Parvovirus B19 Infection and Meconium Peritonitis , 1998, Fetal Diagnosis and Therapy.

[17]  S. Craigo,et al.  The natural history of meconium peritonitis diagnosed in utero. , 1995, Journal of pediatric surgery.

[18]  T. Yoong,et al.  Standardisation and adaptation of the Denver Developmental Screening Test (DDST) and Denver II for use in Singapore children. , 1994, Singapore medical journal.

[19]  J. Deutinger,et al.  Meconium peritonitis: Extrusion of meconium and different sonographical appearances in relation to the stage of the disease , 1992, Prenatal diagnosis.

[20]  J. Boix-Ochoa,et al.  [Meconial peritonitis: conclusions based on 53 cases]. , 1990, Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica.

[21]  D. Nyberg,et al.  Meconium peritonitis: prenatal sonographic findings and their clinical significance. , 1987, Radiology.

[22]  D. Tibboel,et al.  The importance of mesenteric vascular insufficiency in meconium peritonitis. , 1986, Human pathology.

[23]  Williams Rd,et al.  Sonographic demonstration of the progression of meconium peritonitis. , 1984 .

[24]  R. Nathan,et al.  Sonographic demonstration of the progression of meconium peritonitis. , 1984, Obstetrics and Gynecology.

[25]  R. Grand,et al.  Gastrointestinal manifestations of cystic fibrosis: a review. , 1981, Gastroenterology.

[26]  S. F. Anderson,et al.  Sonographic findings with radiologic correlation in meconium peritonitis , 1979, Journal of clinical ultrasound : JCU.

[27]  D. Cloud.  Meconium peritonitis: W. S. Lorimer, Jr., and Dick G. Ellis. Surgery 60:470–475, August, 1966 , 1966 .

[28]  H. Shwachman,et al.  A review of 164 children with meconium ileus seen at the Children's Hospital Medical Center, Boston. , 1966, Pediatrics.

[29]  G. Kammerer.  MECONIUM PERITONITIS. , 1965, JAMA.