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Zheng XQ, Wu DM, Chen X, Lin JX, Wang XC, Ren KH, Liu HQ, Xu RL, Yan JY. Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis. J Matern Fetal Neonatal Med 2024; 37:2250045. [PMID: 38403928 DOI: 10.1080/14767058.2023.2250045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/15/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. METHODS The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. RESULTS The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. CONCLUSION Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.
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Affiliation(s)
- Xiu-Qiong Zheng
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Dao-Ming Wu
- Department of Ultrasonography, Clinical Medical School of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xian Chen
- Department of Obstetrics, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Jin-Xiao Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Xue-Chun Wang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Kun-Hai Ren
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Hong-Qing Liu
- Department of Obstetrics, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Rong-Li Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Jian-Ying Yan
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
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Moustafa ASZ, Araji S. Fetal diagnosis of meconium periorchitis: A case report. Clin Case Rep 2023; 11:e8319. [PMID: 38107083 PMCID: PMC10724078 DOI: 10.1002/ccr3.8319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum with echogenic fluid and debris. In this report, we describe a case in which a prenatal diagnosis of MPO was accurately made at 32 weeks of gestation. The neonate delivered without complications, underwent immediate evaluation followed by major surgery, and ultimately had a favorable outcome. An accurate prenatal diagnosis is important to counsel the patient in a multidisciplinary approach. This case highlights the prenatal ultrasound findings as well as the neonatal presentation and the possibility for conservative management by pediatric urology.
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Affiliation(s)
- Ahmed S. Z. Moustafa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Sarah Araji
- Department of Obstetrics and Gynecology, Division of Maternal Fetal MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
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3
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Zhu Y, Zhang M. A rare case of meconium peritonitis characterized mainly by bilateral testicular hydrocele. Asian J Surg 2022:S1015-9584(22)01810-3. [PMID: 36593144 DOI: 10.1016/j.asjsur.2022.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Yujiang Zhu
- Digestive System Department, Yucheng District People's Hospital of Ya'an City, Sichuan Province, Ya'an, 625000, China.
| | - Mengxiao Zhang
- Digestive System Department, Yucheng District People's Hospital of Ya'an City, Sichuan Province, Ya'an, 625000, China
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4
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Fetal Meconium Peritonitis: A Clinical Study of Nine Cases. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8658999. [PMID: 35669660 PMCID: PMC9166987 DOI: 10.1155/2022/8658999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022]
Abstract
Objective To explore the prenatal ultrasonographic characteristics and pregnancy outcomes of fetal meconium peritonitis (FMP). Methods Nine patients diagnosed with FMP by routine prenatal examination between January 2015 and December 2020 were identified. Both prenatal ultrasonographic characteristics and pregnancy outcomes associated with these patients were retrospectively analyzed. Results The mean gestational age at the time of FMP diagnosis was 31.3 ± 4.8 weeks, and the mean gestational age of delivery was 35.1 ± 5.1 weeks. Prenatal ultrasonographic findings at the time of diagnosis in these patients included intestinal dilatation (9/9, 100%), intraperitoneal calcification (8/9, 88.9%), fetal ascites (5/9, 55.6%), intraperitoneal pseudocyst (5/9, 55.6%), and polyhydramnios (6/9, 66.7%). Analyses of the etiological basis for meconium peritonitis in 5 of the 8 live births that underwent surgical treatment revealed 4 cases of congenital volvulus and 1 case of jejunal atresia. Conclusion The prenatal ultrasound manifestations of fetal meconium peritonitis are diverse, and the different grades of prenatal ultrasound manifestations can provide important information for the treatment of perinatal infants.
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Shinar S, Agrawal S, Ryu M, Van Mieghem T, Daneman A, Ryan G, Zani A, Chiu P, Chitayat D. Fetal Meconium Peritonitis - Prenatal Findings and Postnatal Outcome: A Case Series, Systematic Review, and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:194-203. [PMID: 32575129 DOI: 10.1055/a-1194-4363] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery. METHODS We retrospectively reviewed all fetuses with ultrasound findings suspicious for meconium peritonitis at a single center over a 10-year period. A systematic review and meta-analysis were then performed pooling our results with previous studies assessing prenatally diagnosed meconium peritonitis and postnatal outcome. Prenatal sonographic findings were analyzed to identify predictors for postnatal surgery. RESULTS 34 cases suggestive of meconium peritonitis were diagnosed at our center. These were pooled with cases from 14 other studies yielding a total of 244 cases. Postnatal abdominal surgery was required in two thirds of case (66.5 %). The strongest predictor of neonatal surgery was meconium pseudocyst (OR [95 % CI] 6.75 [2.53-18.01]), followed by bowel dilation (OR [95 % CI] 4.17 [1.93-9.05]) and ascites (OR [95 % CI] 2.57 [1.07-5.24]). The most common cause of intestinal perforation and meconium peritonitis, found in 52.2 % of the cases, was small bowel atresia. Cystic fibrosis was diagnosed in 9.8 % of cases. Short-term neonatal outcomes were favorable, with a post-operative mortality rate of 8.1 % and a survival rate of 100 % in neonates not requiring surgery. CONCLUSION Meconium pseudocysts, bowel dilation, and ascites are prenatal predictors of neonatal surgery in cases of meconium peritonitis. Fetuses with these findings should be delivered in centers with pediatric surgery services. Though the prognosis is favorable, cystic fibrosis complicates postnatal outcomes.
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Affiliation(s)
- Shiri Shinar
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Swati Agrawal
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Michelle Ryu
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital Sidney Liswood Health Sciences Library, Toronto, Canada
| | - Tim Van Mieghem
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Alan Daneman
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Greg Ryan
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Augusto Zani
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Priscilla Chiu
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - David Chitayat
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital Sidney Liswood Health Sciences Library, Toronto, Canada
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6
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Cheng Y, Cheng Y. Ovarian cysts. Am J Obstet Gynecol 2021; 225:B23-B25. [PMID: 34507793 DOI: 10.1016/j.ajog.2021.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Feng Y, Zheng H, Zhang G, Zhong W, Guo K, Tang H, Zhong J, Yin W, Wang Z, Mei S, Morse AN. Predicting poor outcomes and the need for surgical treatment in neonates with meconium peritonitis. Prenat Diagn 2019; 40:351-357. [PMID: 31713898 DOI: 10.1002/pd.5608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/24/2019] [Accepted: 10/17/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this study is to determine factors associated with poor outcomes and the need for surgical treatment in neonates with meconium peritonitis (MP). METHODS We evaluated the association between prenatal ultrasound features, maternal characteristics, and the likelihood of surgery, mortality, and serious morbidity in 49 neonates with a prenatal diagnosis of MP, who were born in Guangzhou Women and Children's Medical Center between January 2011 and December 2016. RESULTS Thirty of 49 neonates (61.2%) required surgical treatment, and 17 (34.7%) had a poor outcome. Independent predictors of need for surgical treatment were polyhydramnios, maternal intrahepatic cholestasis of pregnancy (associated with lower risk), and persistence of peritoneal fluid. The model correctly predicted 70.0% of the neonates who required surgery (at a 10% false-positive rate; area under the curve [AUC]: 0.86 [95% CI, 0.75-0.97]). For poor outcomes, independent predictors were low gestational age at birth, persistence of peritoneal fluid, and polyhydramnios. For the latter, the model only achieved a detection rate of 52.9% (10% false-positive rate, AUC: 0.82 [95% CI, 0.70-0.94]). CONCLUSIONS A combination of prenatal ultrasound features and maternal characteristics correctly predicted 70.0% the need for neonatal surgery. Prediction of poor outcome-based prenatal ultrasound features and gestational age did not perform well.
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Affiliation(s)
- Yan Feng
- Fetal Care Center, Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guanglan Zhang
- Fetal Care Center, Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Zhong
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kaimin Guo
- Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haiyang Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junmin Zhong
- Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Yin
- Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhe Wang
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shanshan Mei
- Fetal Care Center, Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Abraham N Morse
- Obstetric & Gynecology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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8
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Erol SA, Sanhal CY, Yılmaz Y, Şahin D. What is your diagnosis? J Turk Ger Gynecol Assoc 2018; 19:165-168. [PMID: 29991467 PMCID: PMC6085520 DOI: 10.4274/jtgga.2018.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Seyit Ahmet Erol
- Clinic of Perinatology, University of Health Sciences, Zekai Tahir Burak Women’s Health Practice and Research Center,
Ankara, Turkey
| | - Cem Yaşar Sanhal
- Clinic of Perinatology, University of Health Sciences, Zekai Tahir Burak Women’s Health Practice and Research Center,
Ankara, Turkey
| | - Yavuz Yılmaz
- Clinic of Pediatric Surgery, University of Health Sciences, Zekai Tahir Burak Women’s Health Practice and Research Center, Ankara, Turkey
| | - Dilek Şahin
- Clinic of Perinatology, University of Health Sciences, Zekai Tahir Burak Women’s Health Practice and Research Center,
Ankara, Turkey
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9
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Matos APP, Duarte LDB, Castro PT, Daltro P, Werner Júnior H, Araujo Júnior E. Evaluation of the fetal abdomen by magnetic resonance imaging. Part 1: malformations of the abdominal cavity. Radiol Bras 2018; 51:112-118. [PMID: 29743740 PMCID: PMC5935407 DOI: 10.1590/0100-3984.2016.0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although ultrasound continues to be the mainstay modality for the evaluation of
fetal disorders, fetal magnetic resonance imaging (MRI) has often been used as a
valuable adjunct in recent years. The exponential growth of the use of fetal MRI
has been facilitated by technological advancements such as ultrafast T2-weighted
sequences and diffusion-weighted imaging. Fetal MRI can achieve results that are
comparable to or better than those of ultrasound, particularly in cases of
maternal obesity, severe oligohydramnios, or abnormal fetal position. Because of
its superior soft tissue contrast, wide field of view, and multiplanar imaging,
fetal MRI is able to evaluate the large fetal organs, such as the lungs, liver,
bowel, and kidneys. In addition, fetal MRI allows large or complex malformations
to be examined, facilitating the understanding of the malformation within the
context of the body as a whole. Initial fetal MRI studies were focused on the
central nervous system. With advances in software and hardware, fetal MRI gained
importance in the evaluation of the fetal abdomen. The purpose of this article
is to review the recent literature and developments in MRI evaluation of the
fetal abdomen, with an emphasis on imaging aspects, protocols, and common
clinical indications.
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Affiliation(s)
- Ana Paula Pinho Matos
- MD, Specialist in Fetal Medicine, Masters Student, Department of Maternal and Child Care, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Luciana de Barros Duarte
- PhD, Adjunct Professor, Department of Maternal and Child Care, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Pedro Teixeira Castro
- MSc, MD, Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Pedro Daltro
- PhD, MD, Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Heron Werner Júnior
- PhD, MD, Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Tenured Adjunct Professor, Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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10
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Stanescu AL, Liszewski MC, Lee EY, Phillips GS. Neonatal Gastrointestinal Emergencies. Radiol Clin North Am 2017; 55:717-739. [DOI: 10.1016/j.rcl.2017.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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11
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Gerscovich EO, Sekhon S, Loehfelm TW, Wootton-Gorges SL, Greenspan A. A reminder of peristalsis as a useful tool in the prenatal differential diagnosis of abdominal cystic masses. J Ultrason 2017; 17:129-132. [PMID: 28856022 PMCID: PMC5516084 DOI: 10.15557/jou.2017.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022] Open
Abstract
With routine antenatal ultrasound and recent advances in ultrasound technology, fetal intraabdominal cystic masses are recognized more often and are better characterized than in the past. They may be classified as solid and cystic, and may originate from multiple structures. When considering the extensive differential diagnosis of cystic masses, the observation of peristalsis narrows the possibilities to the gastrointestinal tract. To find this feature on ultrasound, the examiner must expressly think and look for it, otherwise it may be missed. Our case report illustrates one of those cases.
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Affiliation(s)
| | - Simran Sekhon
- Department of Radiology, UC Davis Health, Sacramento, California
| | | | | | - Adam Greenspan
- Department of Radiology, UC Davis Health, Sacramento, California
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12
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Garofalo G, Tecco L, Van Rysselberge M, Van Bogaert P, Mergan F, Cassart M. Unusual association of brain hemorrhage and digestive tract occlusion: about two prenatal cases. Clin Case Rep 2016; 4:1168-1171. [PMID: 27980755 PMCID: PMC5134217 DOI: 10.1002/ccr3.731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/22/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022] Open
Abstract
We report two prenatal cases of an exceptional association of digestive tract atresia or perforation with brain hemorrhage. This combination worsens the prognosis leading to termination of pregnancy in one case. We outline the importance of a careful fetal brain examination on imaging in cases of prenatal “acute” abdominal insults.
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Affiliation(s)
- Giulia Garofalo
- Fetal Medicine Department CHU St Pierre ULB Brussels Belgium
| | - Laura Tecco
- Fetal Medicine Department CHU St Pierre ULB Brussels Belgium
| | | | | | - Frederic Mergan
- Pediatric Surgery Department CHU St Pierre ULB Brussels Belgium
| | - Marie Cassart
- Fetal Medicine Department CHU St Pierre ULB Brussels Belgium; Perinatal Imaging Radiology Department Etterbeek-Ixelles Hospital Brussels Belgium
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13
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Lee GSY, Chandran S, Rajadurai VS. Calcified meconium pseudocyst: X-ray diagnosis of meconium peritonitis at birth. BMJ Case Rep 2015; 2015:bcr-2015-211052. [PMID: 26153293 DOI: 10.1136/bcr-2015-211052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore Duke- NUS Graduate Medical School, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore Duke- NUS Graduate Medical School, Singapore
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14
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Uchida K, Koike Y, Matsushita K, Nagano Y, Hashimoto K, Otake K, Inoue M, Kusunoki M. Meconium peritonitis: Prenatal diagnosis of a rare entity and postnatal management. Intractable Rare Dis Res 2015; 4:93-7. [PMID: 25984428 PMCID: PMC4428193 DOI: 10.5582/irdr.2015.01011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 11/05/2022] Open
Abstract
The aims of this study were to review our therapy and outcome for meconium peritonitis (MP) patients, and to clarify predictors of postoperative morbidity and mortality. We retrospectively reviewed a total 15 patients with MP who received surgical intervention at our institute from December 1990 to November 2012. Diagnosis of MP was confirmed by operative findings. We analyzed the relationship between outcome and patients' factors including patients' characteristics, prenatal diagnosis, type of MP, general condition, and surgical procedure. There was no relationship between outcome and the following factors: gender, gestational age, body weight at birth, delivery type, Apgar score, prenatal diagnosis, types and causes of MP, and surgical procedure. However, the preoperative presence of circulation deficiency and serum CRP values were statistically significant predictors of outcome in our MP patients. Prenatal diagnosis is essential for the first step of perinatal therapy for MP. Surgical strategy should be selected according to the information of prenatal diagnosis. Early surgical procedures to reduce systemic and abdominal inflammation just after birth may improve the outcome of severe MP cases.
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Affiliation(s)
- Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
- Address correspondence to: Dr. Keiichi Uchida, Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine 2-174 Edobashi, Tsu, Mie 514-8507, Japan. E-mail:
| | - Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kohei Matsushita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuka Nagano
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kiyoshi Hashimoto
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kohei Otake
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
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15
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Trinh TW, Kennedy AM. Fetal Ovarian Cysts: Review of Imaging Spectrum, Differential Diagnosis, Management, and Outcome. Radiographics 2015; 35:621-35. [DOI: 10.1148/rg.352140073] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Postnatal sonographic spectrum of prenatally detected abdominal and pelvic cysts. AJR Am J Roentgenol 2015; 203:W684-96. [PMID: 25415735 DOI: 10.2214/ajr.13.12371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate the sonographic findings of a spectrum of neonatal abdominal and pelvic cystic lesions. CONCLUSION Neonatal abdominal and pelvic cystic lesions can arise from many organs, and they have a broad differential diagnosis. Distinctive sonographic findings may be present and can help establish the correct cause and guide proper management.
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17
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Does meconium peritonitis pseudo-cyst obstruct labour? Case Rep Obstet Gynecol 2012; 2012:593143. [PMID: 22720178 PMCID: PMC3375074 DOI: 10.1155/2012/593143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/04/2012] [Indexed: 11/17/2022] Open
Abstract
Meconium peritonitis pseudo-cyst is very rare. Its perinatal management is controversial and can be associated with increased fetomaternal morbidity and mortality. A 34-week gestation infant with large meconium peritonitis pseudo-cyst, detected by intrapartum fetal ultrasound study, had abnormally increased ratio of fetal abdominal circumference to head circumference. Intrapartum aspiration of the pseudo-cyst was performed and was followed by a smooth vaginal delivery. The postnatal course of the baby showed that early laparotomy was essential for stabilisation of the infant's general condition.
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Minato M, Okada T, Miyagi H, Honda S, Takazawa K, Kubota KC, Todo S. Meconium pseudocyst with particular pathologic findings: a case report and review of the literature. J Pediatr Surg 2012; 47:e9-12. [PMID: 22498414 DOI: 10.1016/j.jpedsurg.2011.11.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 11/18/2011] [Accepted: 11/18/2011] [Indexed: 11/24/2022]
Abstract
Meconium peritonitis is a sterile chemical peritonitis caused by bowel perforation with intraperitoneal extravasation of the meconium in utero. When the inflamed intestinal loops become fixed, meconium peritonitis leads to a cystic cavity with a fibrous wall, and the result is termed cystic-type meconium peritonitis. On the contrary, a meconium pseudocyst has a muscle layer continuous with the normal intestine and is distinguished from cystic-type meconium peritonitis based on the histopathologic findings. This report describes the rare case of a neonate complicated by a meconium pseudocyst, which was successfully treated with 1-stage resection and primary anastomosis. There have been few cases of meconium pseudocysts reported in the literature. Meconium peritonitis should be considered in the differential diagnosis in patients who develop large abdominal cysts with air and fluid content. Cystic-type meconium peritonitis is usually treated using drainage with subsequent elective surgery. However, for a meconium pseudocyst, 1-stage intestinal resection with primary anastomosis may be recommended. A meconium pseudocyst may be treatable using 1-stage resection based on histopathologic features.
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Affiliation(s)
- Masashi Minato
- Department of Pediatric Surgery, Hokkaido University Hospital, Sapporo, Japan.
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Izumi Y, Sato Y, Kakui K, Tatsumi K, Fujiwara H, Konishi I. Prenatal treatment of meconium peritonitis with urinary trypsin inhibitor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:366-368. [PMID: 20878676 DOI: 10.1002/uog.8843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2010] [Indexed: 05/29/2023]
Abstract
We describe a case of congenital meconium peritonitis with progressive fetal ascites and polyhydramnios. Fetal ascites could be only partially reduced on paracentesis at 29 weeks' gestation, and it subsequently increased. Urinary trypsin inhibitor (UTI), a physiological anti-inflammatory substance, was administered into the fetal abdominal cavity at a second paracentesis performed at 35 weeks' gestation. There was a significant amount of fetal ascites remaining 1 day after the second paracentesis, but this completely resolved within 5 days. A healthy infant was delivered vaginally and no surgical intervention was required. The case suggests that UTI can reduce meconium-induced chemical peritonitis and thereby facilitate intrauterine remission of fetal ascites.
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Affiliation(s)
- Y Izumi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Nakajima Y, Masaoka N, Asanuma A, Sone K, Nagaishi M, Miyakawa Y, Yamamoto T, Hoshino M, Koshinaga T. A large meconium pseudocyst that developed into the generalized type during the antepartum period. J Med Ultrason (2001) 2011; 38:37-40. [PMID: 27278337 DOI: 10.1007/s10396-010-0281-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/25/2010] [Indexed: 11/26/2022]
Abstract
A fetal intraabdominal cystic mass, measuring 6 cm, was detected at 30 weeks of gestation in a 27-year-old gravida 2 para 1 woman. At 33 weeks of gestation, the cyst disappeared. Ultrasonography showed fetal bowel dilatation, polyhydramnios, and intraabdominal calcifications. Fetal meconium peritonitis was diagnosed prenatally. Because the fetal ileus became worse, a cesarean section was performed at 35 weeks of gestation; a female infant weighing 2,131 g with an Apgar score of 8 was delivered. Six hours after birth, the neonate received an ileostomy. The bowel was reanastomosed 42 days after the initial operation. On postoperative pathology, a meconium pseudocyst was diagnosed. To our knowledge, this is the first report of a large fetal meconium pseudocyst that developed into the generalized type in the uterus during the preterm antepartum period.
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Affiliation(s)
- Yoshiyuki Nakajima
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524, Japan.
| | - Naoki Masaoka
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Aki Asanuma
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Sone
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Masaji Nagaishi
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuji Miyakawa
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsuo Yamamoto
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Mayumi Hoshino
- Division of Pediatric Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tsugumichi Koshinaga
- Division of Pediatric Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
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Meconium pseudocyst secondary to ileum volvulus perforation without peritoneal calcification: a case report. J Med Case Rep 2010; 4:292. [PMID: 20807399 PMCID: PMC2936322 DOI: 10.1186/1752-1947-4-292] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 08/31/2010] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION A case of giant meconium pseudocyst secondary to ileum volvulus perforation is presented. Conventional radiographic features of meconium peritonitis with secondary meconium pseudocyst formation are well described. Our case is unusual in comparison to other cases reported in the literature and needs to be reported because the meconium pseudocyst presented without the typical ultrasound features (calcifications, polyhydramnios and ascites) and was initially identified as an abdominal mass. CASE PRESENTATION We describe the case of a 29-year-old Caucasian woman in her third trimester of pregnancy, in which an abdominal mass was detected in the fetus. The newborn was diagnosed in the early neonatal period with meconium pseudocyst secondary to ileum volvulus perforation. CONCLUSIONS The prenatal appearance of a meconium pseudocyst can be complemented by other signs of bowel obstruction (if present) such as polyhydramnios and fetal bowel dilatation. This is an original case report of interest to all clinicians in the perinatology and fetal ultrasound field. We consider that the utility of this case is the recognition that a meconium pseudocyst might appear without the typical ultrasound features and should be considered as a differential diagnosis when an echogenic intra-abdominal cyst is seen.
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Abstract
BACKGROUND Meconium peritonitis (MP) develops when bowel perforation occurs in utero or soon after birth, resulting in leakage of meconium into the peritoneal cavity. The clinical features are often variable and prenatal ultrasonography plays an important role in prenatal diagnosis. METHODS We conducted a retrospective review of neonates diagnosed with MP in our hospital from January 1998 to December 2007. Prenatal examinations, postnatal presentations, investigations, management, patient outcomes, and possible causes were analyzed. RESULTS Ten patients (five boys, five girls) diagnosed with MP were studied. The most common prenatal ultrasonographic finding was fetal ascites (7/10, 70%), followed by polyhydramnios (3/10, 30%), bowel dilatation (3/10, 30%), intra-abdominal calcification (1/10, 10%), and hydrops fetalis (1/10, 10%). Two of our patients were completely normal on prenatal ultrasonography. Only one MP diagnosis (1/10, 10%) was definitely confirmed by prenatal ultrasonography due to the presence of ascites, bowel perforation and intra-abdominal calcification. Nine patients (90%) required surgical intervention because of bowel perforation (5), bowel atresia (2), obstruction due to ileus (1), and intussusception (1). Peritonitis was of cystic type in one case (10%), fibroadhesive in five cases (50%), and generalized in four cases (40%). All 10 patients survived without long-term gastrointestinal complications. CONCLUSION Prenatal ultrasonography can be diagnostic for MP, which should be considered in the differential diagnosis of patients presenting with ascites or abdominal distension at birth. Close observation of postnatal clinical manifestations and timely surgical intervention resulted in a high survival rate and favorable outcome in these patients at our hospital.
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Wang CN, Chang SD, Chao AS, Wang TH, Tseng LH, Chang YL. Meconium peritonitis in utero---the value of prenatal diagnosis in determining neonatal outcome. Taiwan J Obstet Gynecol 2009; 47:391-6. [PMID: 19126503 DOI: 10.1016/s1028-4559(09)60004-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Meconium peritonitis (MP) is a chemical peritonitis caused by fetal intestinal perforation in utero. Its incidence is rare, but serious neonatal morbidity or even mortality can occur if the diagnosis is not made until after birth. Prenatal diagnosis is important in prompting early postnatal surgical intervention, and so improving neonatal outcome. MATERIALS AND METHODS Fourteen cases diagnosed in utero with MP from January 1996 to December 2005 were enrolled in this study. The final diagnoses were established by surgical findings or postnatal radiography. The prenatal ultrasound features, neonatal birth characteristics, surgical findings, postnatal management and neonatal outcomes were reviewed. RESULTS All infants received follow-up care at our hospital. Prenatal ultrasound findings included fetal ascites (100%), intra-abdominal calcification (93%), dilated bowel loops (57%), pseudocysts (29%), and polyhydramnios (50%). Four infants (4/14; 28.5%) did not undergo postnatal surgery, but survived well. The mean gestational age at detection was significantly earlier in the non-surgery group (23+/-3.6 weeks) than in the surgery group (31.7+/-2.5 weeks). One infant (7.1%) died because of sepsis after two neonatal operations. The overall survival rate was 92.9%. CONCLUSION MP can be diagnosed by prenatal ultrasound, and the neonatal outcome is favorable. Early detection is not associated with poor neonatal outcome, and selective termination is unnecessary. Resolution of dilated bowel loops and polyhydramnios predict a low rate of postnatal surgical intervention.
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Affiliation(s)
- Chao-Nin Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Pelizzo G, Codrich D, Zennaro F, Dell'oste C, Maso G, D'Ottavio G, Schleef J. Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int 2008; 24:1061-5. [PMID: 18668257 DOI: 10.1007/s00383-008-2194-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2008] [Indexed: 01/13/2023]
Abstract
Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, Children's Hospital of Trieste, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
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Pelizzo G, Codrich D, Zennaro F, Dell'oste C, Maso G, D'Ottavio G, Schleef J. Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int 2008. [PMID: 18668257 DOI: 10.1007/s00383-0 08-2194-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, Children's Hospital of Trieste, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
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Primary colonic congenital infantile fibrosarcoma presenting as meconium peritonitis. Pediatr Surg Int 2008; 24:621-3. [PMID: 18247031 DOI: 10.1007/s00383-008-2113-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2007] [Indexed: 10/22/2022]
Abstract
Congenital infantile fibrosarcoma is a rare soft tissue malignancy that occurs in both axial and extremity locations. We report a case of this tumor arising from the left colon in a newborn presenting with an intrauterine perforation and meconium peritonitis.
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Zangheri G, Andreani M, Ciriello E, Urban G, Incerti M, Vergani P. Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery. Prenat Diagn 2008; 27:960-3. [PMID: 17654754 DOI: 10.1002/pd.1812] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis. STUDY DESIGN We reviewed our cohort of cases of meconium peritonitis (MP) (n = 13/37, 225 pregnancies or 0.3/1000) as well as those published in the English literature with prenatal ultrasonographic findings and postnatal follow-up (n = 56). The total number of cases (n = 69) was divided into 4 grades of progressive severity based on the number of pertinent sonographic findings: grade 0, isolated intra-abdominal calcifications (n = 18); grade 1, intra-abdominal calcifications and ascites (n = 17) or pseudocyst (n = 2) or bowel dilatation (n = 6); grade 2, two associated findings (n = 20); and grade 3, all sonographic features (n = 6). Presence of polyhydramnios was also recorded. Prenatal predictors of need for neonatal surgery and risk of neonatal death were identified using Chi-square and Fisher exact test, with P < 0.05 considered significant. RESULTS Neonatal surgical intervention was required in 0% (0/18) of newborns with grade 0 MP; in 52% (13/25) of those with grade 1; in 80% (16/20) with grade 2; and in 100% (6/6) with grade 3 MP (P < 0.001, Chi-square for trend). Moreover, neonatal surgery was more frequent in the presence than absence of polyhydramnios [69% (18/26) vs 37% (16/43); P = 0.007]. Neonatal mortality was 6% (4/69; 3 after surgery and 1 for premature delivery) and it was confined to the subgroup with polyhydramnios (4/26, 15%). CONCLUSIONS Prenatal sonographic features are related to postnatal outcome. Persistently isolated intra-abdominal calcifications have an excellent outcome. Delivery in a tertiary care center is recommended when calcifications are associated with other sonographic findings.
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Simonovský V, Lisý J. Meconium pseudocyst secondary to ileal atresia complicated by volvulus: antenatal MR demonstration. Pediatr Radiol 2007; 37:305-9. [PMID: 17206405 DOI: 10.1007/s00247-006-0365-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Revised: 10/18/2006] [Accepted: 10/29/2006] [Indexed: 10/23/2022]
Abstract
We report a case of meconium pseudocyst evaluated by prenatal MR imaging. The unusual features were its huge size, the absence of meconium peritonitis, and its development late in fetal life. The case also demonstrates a possible diagnostic pitfall since it suggests that rapid deterioration of a mechanically compensated bowel obstruction may occur, potentially occurring only after an MRI study has been performed.
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Affiliation(s)
- Václav Simonovský
- Clinic of Imaging Methods, Faculty Hospital Motol and 2nd Medical Faculty, Charles University, V úvalu 84, Prague, 150 18, Czech Republic.
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Wax JR, Pinette MG, Cartin A, Blackstone J. Prenatal sonographic diagnosis of meconium periorchitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:415-7. [PMID: 17324997 DOI: 10.7863/jum.2007.26.3.415] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Joseph R Wax
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME, USA.
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Malpas TJ, MacLachlan N, Dykes E, Kiely EM. Prenatal intestinal perforation and intra-abdominal lymphangioma. Prenat Diagn 2007; 27:882-3. [PMID: 17602448 DOI: 10.1002/pd.1794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chan KL, Tang MHY, Tse HY, Tang RYK, Tam PKH. Meconium peritonitis: prenatal diagnosis, postnatal management and outcome. Prenat Diagn 2006; 25:676-82. [PMID: 16049997 DOI: 10.1002/pd.1221] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Prenatal ultrasonography (USS) is a routine screening test for fetal abnormalities. Its accuracy for detecting meconium peritonitis (MP), which may carry high mortality, is important for prenatal counseling. The aim of this study was to assess the accuracy of prenatal USS for diagnosing MP and predicting patient outcomes. METHODS The prenatal and postnatal medical records of all patients referred to our institutions with confirmed MP were reviewed, with emphasis on prenatal USS findings, results of postnatal investigations, operative findings, outcomes, and possible causes of MP. RESULTS From January 2000 to November 2004, seven fetuses were confirmed to have MP at birth. Three MP patients (3/7, 43%) were diagnosed prenatally because of USS showing ascites and calcification/dilated or hyperechoic bowel loops. One (1/7, 14.3%) suspected cystic MP was confirmed by prenatal MRI. In the other three cases, USS showed only ascites. All patients had postnatal contrast CT scans. Two patients' CT scans showed persistent intestinal perforation not visible with prenatal USS, and required emergency operations. All patients survived and prospered, and were sweat test negative. CONCLUSIONS Prenatal USS allows suspected MP babies to be transferred to a tertiary centre for delivery and appropriate management. In this way, the chances of survival of these babies can be excellent if they are not associated with cystic fibrosis (CF). Prenatal MRI can improve the low diagnostic yield of prenatal USS for MP. Postnatal contrast CT scan is required to define persistent intestinal perforation invisible with prenatal USS.
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Affiliation(s)
- K L Chan
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China.
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Wu CH, Lu F, Huang TH. Meconium Peritonitis Presenting as a Solitary Calcified Mass on Ultrasound at Mid-trimester and Identified with Fetal Magnetic Resonance Imaging. J Med Ultrasound 2006. [DOI: 10.1016/s0929-6441(09)60090-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Manikoth P, Vaishnav A, Zachariah N, Sajwani MJ, Nair AK, Pai MG. Meconium peritonitis secondary to torsion of fallopian tube cyst and transient central diabetes insipidus in a preterm infant. J Perinat Med 2005; 33:76-8. [PMID: 15841620 DOI: 10.1515/jpm.2005.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.
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