Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course.
OBJECTIVE
Intra-uterine bowel perforation can occur secondary to a variety of abnormalities and cause sterile peritonitis in the fetus (generalised = type I). If sealing of the perforation does not take place, a thick-walled pseudo-cyst can form (type II).


METHODS
Over a 12-year period, 21 616 pregnancies were screened for gastro-intestinal malformations using prenatal ultrasound. We identified 1077 cases suspicious of surgically correctable malformations. Post-natal diagnoses and outcome were worked up retrospectively.


RESULTS
We found 96 fetuses with suspected gastro-intestinal malformations. Prenatal bowel perforation with meconium peritonitis was confirmed in 11 cases. In 5 of these 11, the correct diagnosis had been predicted prenatally. One child presented as a fetal and neonatal emergency (case report). Ten of the eleven infants were operated on during their first day of life. Intra-operative findings were atresia (n = 4), meconium ileus (n = 6) and no obvious cause (n = 1). Two children suffered fatal complications.


CONCLUSIONS
Meconium peritonitis and meconium pseudo-cysts as its special manifestation are assessable by prenatal diagnosis but present in different ways. They can present as fetal ascites or echogenic bowel and cause fetal or neonatal distress, requiring close observation and highly specialised care.
Eckoldt
F
F
Klinik und Poliklinik für Kinderchirurgie, Universitätsfrauenklinik der Medizinischen Fakultät (Charité), Humboldt-Universität zu Berlin, Germany. felieckoldt@gmx.de
Heling
K S
KS
Woderich
R
R
Kraft
S
S
Bollmann
R
R
Mau
H
H
D000328:Adult; D003560:Cysts / Q000151:congenital / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging; D008297:Male; D008470:Meconium; D010538:Peritonitis / Q000151:congenital / Q000000981:diagnostic imaging* / Q000209:etiology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal