Meconium peritonitis with pseudocyst formation

Case contributed by Dr Hisham Alwakkaa

Presentation

Premature newborn (born at 34 weeks) with history of prenatal meconium peritonitis and meconium pseudocyst.

Patient Data

Age: 0 day
Gender: Male

There is a large irregular calcification in the right abdomen. A large gas bubble occupying most of the right abdomen is also present with large air-fluid level on the left decubitus view of the abdomen.

Bowel loops demonstrate mild gaseous distension and mainly located in the left abdomen.

Tubes and lines are in satisfactory positions.

Low lungs volume with diffuse hazy opacification and central bronchograms consistent with surfactant deficiency disorder.

Microcolon (unused colon) appearance of the rectosigmoid, descending and distal transverse colon. Contrast could not be passed more proximally, despite multiple attempts, which is indicating obstruction at this level.

Case Discussion

Meconium peritonitis is an in utero sterile chemical peritonitis results from meconium leak into the peritoneal cavity through a bowel perforation. It might worth mentioning here that meconium calcifies rapidly within the peritoneum, sometimes within 24 hrs.  

The case was diagnosed prenatally in an outer facility and unfortunately, we could not obtain the prenatal imaging.

 At surgery, they found a distal ileal perforation with huge cyst occupying most of the right abdomen. The cyst contained a large amount of meconium and air within it and caused an extrinsic compression over the transverse colon resulting in a colonic obstruction at this level. They were extensive adhesions between the cyst and anterior abdomen wall and surrounding bowel loops.

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Case information

rID: 60262
Published: 14th May 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Women and children Hospital of Buffalo

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