Meconium peritonitis

Boopathy Vijayaraghavan1, Nirmala Balakumar2

1 Sonoscan, Ultrasonic Scan Centre, 16.B Venkatachalam Road, R.S.Puram; 2 Udumalpet, Coimbatore. 641002, India.

Synonym: Chemical peritonitis, meconium pseudocyst, fibro-adhesive peritonitis.

Case Report: 27-year-old woman G3 P I, with 1 live male child of 5 years, was referred for sonography to rule out fetal anomalies, because of fetal ascites in earlier scan. The gestational age was 30 weeks which was confirmed by the biometry. There was polyhydramnios and ascites. There was sludge-like material in the ascites. There were multiple calcifications in ascites. During scanning, the fetus turned and the calcifications moved in the ascites (video). These features suggested meconium peritonitis. There was a loop of bowel with brightly echogenic shadows in the lumen (figure 4). There was no other anomaly.

Definition: The condition occurs when perforation of bowel occurs in fetus.

Antenatal sonographic features already described are;
1. Isolated ascites
2. ascites with sludge like material
3. meconium pseudocyst
4. intraabdominal calcifications
5. bowel dilatation
6. calcification in scrotum and hydrocele
7. polyhydramnios

In this case ascites with sludge-like material and calcifications moving in the ascitis are seen. Meconium calcifications hae also been reported within dilated colon in cases of anal atresia with urinary fistula.

The parents chose to terminate the pregnancy. They refused an autopsy. Needle aspiration of ascitic fluid revealed a light yellow fluid.





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