morphine and Intestinal-Perforation

Meconium peritonitis (MP) is a sterile, chemical peritonitis resulting from in-utero fetal bowel perforation. Severe cases may lead to serious morbidities and mortalities.. To review the common antenatal ultrasound abnormalities associated with MP, and identify radiological and clinical prognostic factors.. Retrospective review of all neonates with MP from January 1997 to December 2019 treated in our hospital was performed. Antenatal ultrasound findings, clinical presentations and outcomes were analyzed.. Thirty-five neonates (17 males, 18 females) were included in the study. Thirty-two (91.4%) attended antenatal screening, and 27 (84.4%) of them had abnormalities identified on antenatal ultrasound. The most common abnormality was polyhydramnios (43.8%). Nineteen (54.3%) patients were inborn. Twenty (57.1%) patients were born prematurely. Laparotomy was required in 85.7% of patients. The median time to laparotomy was shorter in the inborn group [1 day (0-9 days) vs 4 days (2-34 days), p = 0.001], but the duration of post-operative hospital stay was comparable [71 days (16-423 days) vs 73.5 days (23-231 days)]. However, such duration was found to be significantly longer in the pre-term group when compared to full-term [58.5 days (16-89 days) vs 85 (21-423 days), p = 0.01]. The most common pathology was small bowel atresia and there were two mortalities.. Due to the advancement in prenatal detection, pediatric anesthesia, intensive care and surgical techniques, the morbidity and mortality of MP has much decreased. Effective multi-disciplinary antenatal counseling facilitated the perinatal management of MP and resulted in comparable prognosis and outcome in inborn and outborn neonates.

Topics: Child; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Tertiary Care Centers; Ultrasonography, Prenatal

 To describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery..  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..  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..  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.. ZIEL:  Beschreibung des postnatalen Outcomes der fetalen Mekoniumperitonitis und Identifizierung pränataler Prädiktoren für die neonatale Chirurgie..  Wir untersuchten an einem einzigen Zentrum über 10 Jahre hinweg retrospektiv alle Föten mit Ultraschallbefunden, bei denen der Verdacht einer Mekoniumperitonitis bestand. Eine systematische Übersicht und eine Metaanalyse wurden daraufhin durchgeführt, um unsere Ergebnisse mit früheren Studien zur Beurteilung der pränatalen Mekoniumperitonitis und des postnatalen Outcomes zusammenzufassen. Die pränatalen sonografischen Befunde wurden analysiert, um Prädiktoren für die postnatale Chirurgie zu identifizieren..  In unserem Zentrum gab es 34 Fälle mit Verdachtsdiagnose Mekoniumperitonitis. Diese wurden mit Fällen aus 14 anderen Studien zusammengefasst, sodass sich insgesamt 244 Fälle ergaben. In 2 Drittel der Fälle (66,5 %) war eine postnatale abdominale Operation erforderlich. Der stärkste Prädiktor für die neonatale Chirurgie war eine Mekonium-Pseudozyste (OR 6,75; 95 %-KI 2,53–18,01), gefolgt von Darmdilatation (OR 4,17; 95 %-KI 1,93–9,05) und Aszites (OR 2,57; 95 %-KI 1,07–5,24). Die häufigste Ursache für Darmperforation und Mekoniumperitonitis, die in 52,2 % der Fälle gefunden wurde, war die Dünndarmatresie. Mukoviszidose wurde in 9,8 % der Fälle diagnostiziert. Das Kurzzeit-Outcome bei Neugeborenen war günstig, mit einer postoperativen Mortalitätsrate von 8,1 % und einer Überlebensrate von 100 % bei Neugeborenen, die nicht operiert werden mussten..  Mekonium-Pseudozysten, Darmdilatation und Aszites sind pränatale Prädiktoren für eine neonatale Chirurgie bei Mekoniumperitonitis. Bei Föten mit diesen Befunden sollte die Entbindung in Zentren mit dem Schwerpunkt Neugeborenenchirurgie erfolgen. Obwohl die Prognose günstig ist, erschwert Mukoviszidose das postnatale Outcome.

Topics: Child; Female; Humans; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal

To assess the importance of prenatal ultrasound diagnosis of the fetus carrying meconium periorchitis and its predictive relevance for fetal monitoring and prognosis in the context of acute fetal intestinal disease.. Three male fetuses have been diagnosed of meconium periorchitis in our Unit of Fetal Medicine in the last 5 years. Their prenatal ultrasound diagnoses were: testicular tumor (n=1); Meconium periorchitis with acute fetal intestinal perforation (n=2). Gestational age at diagnosis was 33, 34 and 35 weeks. Ultrasound signs at diagnosis were: Increased size of scrotal zone, with hyperechogenic lesions inside and permanence of peritoneum-vaginal canal; at abdominal zone, echographic signs of intestinal disease with or without meconium peritonitis were found (hyperechogenic lesions, edema of intestinal loops and ascites). All three neonates were assessed postnatally by ultrasound and therapeutic indication.. Fetal ultrasound findings influenced both evolution and termination of pregnancy. The diagnosis of meconium periorchitis was confirmed postnatally in all cases: in the 1st case, delivered at term, scrotal tumoral pathology was ruled out and did not require abdominal surgery; the other 2 patients were delivered at the same week of prenatal diagnosis and an inguinal-scrotal surgery with intestinal approach because of meconium peritonitis was performed. No patient underwent orchiectomy, maintaining the teste-epididymal binomial intact.. Prenatal ultrasound diagnosis of meconium periorchitis requires a strict ultrasound follow-up of the fetus as it is a specific marker of intestinal perforation, which can lead to the termination of pregnancy and avoid appearance of complicated meconium peritonitis.. Evaluar la importancia del diagnóstico ecográfico prenatal del feto portador de periorquitis meconial y su relevancia predictiva del seguimiento y pronóstico fetal en el contexto de una enfermedad intestinal fetal aguda.. En los últimos 5 años en la Unidad de Medicina Fetal se han diagnosticado tres fetos varones de periorquitis meconial cuyos diagnósticos ecográficos prenatales fueron: tumor testicular (n=1); y periorquitis meconial con perforación intestinal aguda fetal (n=2). La edad gestacional al diagnóstico fue de 33, 34 y 35 semanas. Los signos ecográficos al diagnóstico fueron: a nivel escrotal, aumento del tamaño, lesiones hiperecogénicas y permanencia del conducto peritoneo-vaginal; a nivel abdominal pueden existir signos ecográficos de enfermedad intestinal con o sin peritonitis meconial (lesiones hiperecogénicas, edemas de asas y ascitis). Los tres neonatos fueron evaluados postnatalmente mediante ecografía comparativa de los hallazgos prenatales e indicación terapéutica.. Los hallazgos ecográficos fetales influyeron en la evolución y finalización de la gestación. El diagnóstico de periorquitis meconial fue confirmado postnatalmente en los tres casos: en el 1er caso a término, se descartó patología tumoral escrotal y no requirió cirugía abdominal; en los otros dos pacientes se indicó finalizar la gestación tras el diagnóstico prenatal y se realizó cirugía inguino-escrotal y abordaje intestinal por la peritonitis meconial.. El diagnóstico ecográfico prenatal de periorquitis meconial obliga a un seguimiento ecográfico estricto del feto al ser un marcador específico de perforación intestinal, que puede conllevar la finalización de la gestación y evitar la aparición de una peritonitis meconial complicada.

Topics: Adult; Female; Gestational Age; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Orchitis; Pregnancy; Ultrasonography, Prenatal; Young Adult

We present the case of an infant born with scrotoschisis and evidence of meconium periorchitis and peritonitis. A scrotal defect was noted with exposure of the left testis and spermatic cord. Meconium peritonitis and periorchitis were confirmed on operative exploration. Given the history, cystic fibrosis was suspected, but initial screening and diagnostic tests were negative.

Topics: Cystic Fibrosis; Diagnosis, Differential; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Orchiectomy; Orchitis; Peritonitis; Radiography, Abdominal; Scrotum; Testicular Diseases; Testis

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.

Topics: Female; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Intestine, Small; Meconium; Peritonitis

Meconium peritonitis (MP) is defined as a sterile inflammatory reaction in the fetal abdomen that is seen in cases of intrauterine bowel perforation. Recently, there have been increasing numbers of fetuses with MP prenatally diagnosed by ultrasonography. Massive fetal ascites in MP may cause hydrops and hypoplastic lungs. However, antepartum management of MP has not yet been established. We encountered a fetus with MP and massive ascites. Repeated paracentesis between 29 weeks and 4 days and 31 weeks and 6 days of gestation prevented the progression to fetal hydrops and hypoplastic lungs, which may occur due to massive meconium ascites with an increased preload index. Amniocentesis was also performed in patients with polyhydramnios for treatment of preterm labor. These observations suggest that aggressive therapy can prolong the gestation period and improve MP treatment outcomes.

Topics: Adult; Ascites; Female; Fetal Diseases; Gestational Age; Humans; Ileal Diseases; Infant; Intestinal Perforation; Labor, Induced; Live Birth; Male; Meconium; Paracentesis; Peritonitis; Pregnancy; Reoperation; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed; Ultrasonography, Prenatal

Retained meconium resulting in intestinal obstruction in infants with very low birth weight (VLBW) may cause significant morbidity and even mortality. Immature intestinal neuromuscular function, abnormal meconium composition, and maternal magnesium sulfate therapy results in delay of first meconium passage. This "normal" passage of first meconium may not occur until 1 week of life or later. A spectrum of conditions results from this delayed passage. At the most serious end of this continuum is intestinal obstruction. These patients present with abdominal distension, emesis, and reduced stool frequency. Early diagnosis of this condition using plain abdominal radiographs and contrast enemas where appropriate is imperative. Contrast enemas may be both diagnostic and therapeutic. Most patients do not need surgical intervention. Operation is indicated when enemas fail to relieve the obstruction or perforation occurs. Prompt diagnosis and appropriate management results in a good outcome. Meconium obstruction in VLBW infants does not appear to be associated with cystic fibrosis or Hirschsprung's disease.

Topics: Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Meconium

A case is presented in which extension of meconium peritonitis through muscular defects in the diaphragm lead to intrathoracic calcifications diagnosed sonographically at 23 weeks of gestation. There were three diaphragmatic defects, two small ones corresponded to foramina of Morgagni and one large posterior defect that did not correspond to the foramen of Bochdelak. There were three additional muscular defects: one in the rectus abdominus and two, bilaterally, in the loins. Despite long-standing fetal ascites and fresh intraperitoneal meconium at laparotomy, postoperative progress was uneventful. The baby did not have other dysmorphic features except for a single palmar crease, the chromosomes were normal, and the baby did not have cystic fibrosis. Follow-up examination at 10 months showed a thriving infant with mild hypotonia and developmental delay, but no respiratory or gastrointestinal problems.

Topics: Adult; Calcinosis; Cesarean Section; Chromosome Aberrations; Chromosome Disorders; Female; Hernia, Diaphragmatic; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Laparotomy; Male; Meconium; Peritonitis; Pregnancy; Thoracic Diseases; Tomography, X-Ray Computed; Ultrasonography

We present a case of meconium peritonitis which was associated with a short bowel and complicated by progressive bowel distension and difficulty in making a definitive diagnosis of cystic fibrosis. Treatment was by bowel resection and an ileostomy (and later bowel anastomosis), followed by parenteral nutrition which was complicated by hepatitis. The literature is reviewed and management dilemmas and options are discussed.

Topics: Adult; Cystic Fibrosis; Female; Fetal Diseases; Humans; Ileostomy; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Karyotyping; Male; Meconium; Parenteral Nutrition; Peritonitis; Polyhydramnios; Pregnancy; Ultrasonography, Prenatal

Fetal intestinal perforation causes a sterile inflammatory reaction of the peritoneum called meconium peritonitis. Twelve patients studied in the perinatal period serve to describe the classical fetal and neonatal signs and symptoms, the iconographical findings, treatment and prognosis. All but one infant, with a meconium pseudocyst, presented with the fibro-adhesive variety. Two were caused by cystic fibrosis, two by organic obstruction, one by fetal appendicitis and another two by ischemic necrosis of part of the ileum. In one of the latter two, the probable mechanism was feto-fetal embolisation following the in utero death of a co-twin. One idiopathic perforation, diagnosed in a preterm infant, healed spontaneously. The neonatal mortality rate was 18%. Primary enteric anastomosis was feasible in 3, Bishop-Koop anastomosis in 2 and an intestinal stoma in two others. Apart from the two survivors with cystic fibrosis, seven have no late gastro-intestinal sequelae.

Topics: Female; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Prenatal Diagnosis; Tissue Adhesions

Topics: Acetylcysteine; Adolescent; Autopsy; Child; Child, Preschool; Cystic Fibrosis; Female; Humans; Hydrogen Peroxide; Ileum; Infant; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Male; Meconium; Pancreatin; Peritonitis; Prognosis; Radiography, Abdominal; Therapeutic Irrigation; Vitamin K Deficiency

Topics: Birth Weight; Contrast Media; Enterocolitis, Pseudomembranous; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Mucosa; Intestinal Perforation; Intestines; Male; Meconium; Necrosis; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; Radiography

In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs, such as pseudocysts, can. be detected during the fetal period so that more patients can be diagnosed prenatally and receive surgery. in the early stage of life. The survival rate of MP has increased up to 80% in recent years. According to. a review of the treatment and outcomes of patients diagnosed with MP, we evaluated the influence of. early operation on survival rate and discussed the risk factors of prognosis.. We collected 79 cases of patients diagnosed with MP who were treated in our department. from October 2001 to December 2017. They were divided into 2 groups. Patients in group A were born. in our hospital. Patients in group B were born in a local hospital with suspicion of MP and then transferred. to our department.. The birth weight (BW) and gestational age (GA) of patients were higher in group A than in. group B. There was no significant difference in the proportion of premature and low birth weight (LBW). patients between the two groups (p = 0.422, p = 0.970). Their age at the time of surgery was younger in. group A than in group B (1.4 ± 2.0 vs. 6.9 ± 14.9, p < 0.001). The overall survival rate of group A was higher. than that of group B (95.0% vs. 79.5%, p = 0.038). The prognosis of premature patients was worse than. that of full-term infants for both groups (p = 0.012).. Prematurity is a significant risk factor related to death for MP patients. The survival rate. of MP patients can be improved by early operation during the neonatal period.

Topics: Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Perforation; Magnetic Resonance Imaging; Male; Meconium; Peritonitis; Prenatal Diagnosis; Prognosis; Retrospective Studies; Survival Rate; Time-to-Treatment; Ultrasonography, Prenatal

Topics: Diagnosis, Differential; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Male; Meconium; Pneumoperitoneum; Testicular Hydrocele

Topics: Ascites; Fatal Outcome; Fetal Diseases; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Respiratory Distress Syndrome, Newborn

Meconium peritonitis is a sterile chemical peritonitis preceded by bowel perforation, resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The presentation can range from simple failure of the neonate to pass meconium to complications such as persistent pulmonary hypertension, lung hypoplasia, and systemic inflammatory syndrome. The purpose of this article is to review a case of meconium peritonitis while considering its etiology, diagnosis, management, and multidisciplinary team care.

Topics: Adult; Education, Nursing, Continuing; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Middle Aged; Neonatal Nursing; Nurses, Neonatal; Peritonitis; Practice Guidelines as Topic; Treatment Outcome

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.. We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014.. 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.. 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.

Topics: Ascites; Cohort Studies; Combined Modality Therapy; Digestive System Abnormalities; Female; Follow-Up Studies; Gestational Age; Humans; Incidence; Infant, Newborn; Intestinal Perforation; Intestine, Small; Male; Meconium; Peritonitis; Postoperative Complications; Pregnancy; Prognosis; Retrospective Studies; Singapore; Survival Analysis; Ultrasonography, Prenatal

Very low birth weight infants (VLBWIs) are at risk of surgical intestinal disorders including necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI). We conducted this study to verify whether the timing of stoma closure and that of enteral nutrition establishment after stoma closure in VLBWIs differ among the most common disorders.. A retrospective multicenter study was conducted at 11 institutes. We reviewed the timing of stoma closure and enteral nutrition establishment in VLBWIs who underwent stoma creation for intestinal disorders.. We reviewed the medical records of 73 infants: 21 with NEC, 24 with FIP, and 25 with MRI. The postnatal age at stoma closure was 107 (28-359) days for NEC, 97 (25-302) days for FIP, and 101 (15-264) days for MRI (p = 0.793), and the postnatal age at establishment of enteral nutrition was 129 (42-381) days for NEC, 117 (41-325) days for FIP, and 128 (25-308) days for MRI (p = 0.855). The body weights at stoma closure were 1768 (620-3869) g for NEC, 1669 (1100-3040) g for FIP, and 1632 (940-3776) g (p = 0.614) for MRI. There were no significant differences among the three groups.. The present study revealed that the time and body weights at stoma closure and the postoperative restoration of bowel function in VLBWIs did not differ among the three diseases.

Topics: Age Factors; Body Weight; Enteral Nutrition; Enterocolitis, Necrotizing; Female; Humans; Ileus; Infant; Infant, Newborn; Infant, Very Low Birth Weight; Intestinal Perforation; Male; Meconium; Multicenter Studies as Topic; Retrospective Studies; Risk; Surgical Stomas; Time Factors; Treatment Outcome

There are five reported cases of fetal meconium peritonitis developing after episodes of maternal hepatitis. These cases demonstrate a potential association between severe maternal liver injury and subsequent fetal meconium peritonitis.. A 26-year-old primigravid woman developed acute liver failure 4 days after unilateral oophorectomy for ovarian torsion at 24 weeks of gestation. Her liver function gradually normalized with conservative management. She was readmitted for acute abdominal pain with elevated blood pressure at 29 weeks of gestation. An emergency cesarean delivery was performed for severe preeclampsia. Her neonate was noted to have a distended abdomen. Laparotomy and bowel resection were performed for meconium peritonitis and bowel perforation.. Fetal meconium peritonitis may develop after severe maternal liver disease. Thus, the latter may warrant heightened fetal surveillance.

Topics: Adult; Cesarean Section; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Intestinal Perforation; Liver Failure, Acute; Male; Meconium; Obstetric Surgical Procedures; Ovariectomy; Peritonitis; Pre-Eclampsia; Pregnancy

Surgical intestinal disorders (SID), such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in extremely low birth weight (ELBW, birth weight <1000 g) infants. From 2010, we performed enteral antifungal prophylaxis (EAP) in ELBWI to prevent for SID. The aim of this study was to identify disease-specific risk factors and to evaluate the efficacy of prevention for SID in ELBW infants.. A retrospective chart review of all consecutive patients between January 2006 and March 2015, which included 323 ELBW infants who were admitted to Shizuoka Children's Hospital, was conducted.. The number of infants with NEC, FIP, and MRI was 9, 12, and 13, respectively; 28 in 323 ELBW infants died. The control group defined the cases were not SID. In-hospital mortality was higher in infants with NEC relative to those in the control group. On logistic regression analysis, low gestational age and cardiac malformations were associated with increased risk of NEC. IUGR were associated with increased risk of MRI. EAP decreased risk of NEC and FIP. Low gestational weight and NEC were associated with increased risk of death.. Survival to hospital discharge after operation for NEC in ELBW infants remains poor. EAP decreased risk of NEC and FIP in ELBW infants.

Topics: Case-Control Studies; Enterocolitis, Necrotizing; Female; Gestational Age; Heart Defects, Congenital; Humans; Ileus; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Intestinal Perforation; Male; Meconium; Retrospective Studies; Risk Factors

Intestinal volvulus is a life-threatening emergency requiring prompt surgical management. Prenatal intestinal volvulus is rare, and most are secondary to intestinal atresia, mesenteric defect or without any underlying cause. Cystic fibrosis (CF) is known to cause digestive tract disorders. After birth, 10-15% of newborns with CF may develop intestinal obstruction within a few days of birth because of meconial ileus.

Topics: Adult; Anastomosis, Surgical; Cesarean Section; Cystic Fibrosis; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Intestinal Volvulus; Male; Meconium; Pneumoperitoneum; Pregnancy; Radiography; Treatment Outcome; Ultrasonography, Prenatal

This is an unusual case in comparison to other sonographically described prenatal cases due to very early diagnosis and surgical intervention following prompt delivery. A 40-year-old pregnant, ultrasonography showed presence of cystic structure in the fetal abdomen that was consistent with intestinal dilatation. At 32 weeks' of gestation, repeat ultrasound showed collapse of the bowel dilatation along with the presence of hyperechogenic fluid in the fetal abdominal cavity. Cesarean section was performed. The clinical utility of this report is the recognition that meconium peritonitis (MP) may be diagnosed in the acute phase with typical ultrasound features, and should be considered in the differential diagnoses of cases presented with reduced fetal movements. Although it appears that morbidity and mortality in MP cases depend upon gestational age, this case report may help to manage similar cases for defining the appropriate delivery time and treatment modality after prenatal identification of the problem.

Topics: Abdomen; Adult; Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Intestinal Volvulus; Male; Meconium; Peritonitis; Pre-Eclampsia; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal

Topics: Abdomen; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Meconium; Peritonitis; Radiography, Abdominal; Treatment Outcome

This study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results.. This study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups.. Overall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person).. US-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.

Topics: Acetylcysteine; Birth Weight; Cathartics; Contrast Media; Diatrizoate Meglumine; Enema; Expectorants; Female; Gestational Age; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Iothalamic Acid; Male; Meconium; Radiography; Retreatment; Sodium Chloride; Time Factors; Treatment Outcome; Ultrasonography, Interventional

Autoimmune hepatitis (AIH) in pregnancy can affect both fetal and maternal outcomes. Little is known regarding the fetal outcomes of AIH in pregnancy. The major risks include spontaneous abortions, fetal mortality, perinatal mortality and prematurity. Two common drugs used in the management of AIH, azathioprine and prednisone, may also be associated with adverse fetal outcomes. We present the case of perinatal focal intestinal perforation with a meconium pseudocyst in a preterm infant of a mother with autoimmune hepatitis on azathioprine and methylprednisone.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Azathioprine; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Hepatitis, Autoimmune; Humans; Ileostomy; Immunosuppressive Agents; Infant, Newborn; Infant, Premature; Intestinal Perforation; Laparotomy; Male; Meconium; Peritonitis; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Risk Factors; Treatment Outcome; Ultrasonography

Intestinal atresia type III B (apple peel) and gastroschisis are both congenital malformations who require early surgical correction in neonatal age. Their association is very rare. We present the case of a full term infant with partial apple peel ileal atresia and a small defect of the anterior abdominal wall, complicated by in utero intestinal perforation and subsequent meconial peritonitis. We observed a partial atresia of small intestine, with involvement of terminal ileus savings of jejunum and a large part of the proximal ileum, small anterior abdominal wall defect with herniation of few bowel loops, intestinal malrotation. Paralytic ileus and infections are the main causes of morbidity and mortality at neonatal age. In our case, in spite of the mild phenotype, prognosis has been complicated by the onset of functional bowel obstruction, caused by chemical peritonitis resulting from contact with either amniotic fluid and meconium.

Topics: Abdominal Wall; Bacteremia; Fatal Outcome; Female; Hernia, Abdominal; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Uterine Perforation

Prenatal ultrasound (US) diagnosis of fetal intra-abdominal calcification (iAC) is frequently caused by an in utero perforation causing meconium peritonitis. Our ability to predict which fetuses will require postnatal surgery is limited. The aim of our study is to correlate iAC and associated US findings with postnatal outcome.. A single centre retrospective review of all cases of fetal iAC diagnosed between 2004 and 2010 was performed. Maternal demographics, fetal US findings, and outcomes (need for surgery and mortality) were collected. Descriptive and comparative statistical analyses were performed.. Twenty-three cases of iAC were identified. There were no cases of fetal demise or postnatal deaths. Three liveborns (13%) required abdominal surgery at a median of 2 days (0-3) for intestinal atresia. US findings of iAC and dilated bowel with (p=0.008) or without (p=0.005) polyhydramnios predicted a need for postnatal surgery as did the combination of iAC, polyhydramnios, and ascites (p=0.008). Conversely, iAC alone or associated with oligohydramnios, polyhydramnios, ascites, or growth restriction did not predict need for postnatal surgery.. The majority of fetuses with iAC on prenatal US do not require surgery. Associated US findings (bowel dilation) can be used to select fetuses for delivery in neonatal surgical centres.

Topics: Abdomen; Ascites; Calcinosis; Delivery Rooms; Delivery, Obstetric; Dilatation, Pathologic; Early Diagnosis; Female; Fetal Diseases; Fetal Growth Retardation; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Oligohydramnios; Operating Rooms; Patient Selection; Peritonitis; Polyhydramnios; Pregnancy; Retrospective Studies; Treatment Outcome; Ultrasonography, Prenatal

Meconium peritonitis is caused by an intestinal perforation that may occur in the fetus, followed by severe chemical peritonitis, resulting in high morbidity.. We have experienced six patients with meconium peritonitis. Cystic drainage was performed soon after birth for all patients. We investigated the concentrations of several cytokines and a chemokine (interleukin 8) in the ascites from the six patients with meconium peritonitis. In two patients we also measured the serum cytokines and chemokine level just after birth.. Interleukin 6 and interleukin 8 concentrations were very high in the cyst or ascites just after birth. In the serum taken from two patients, the levels of interleukin 6 and interleukin 8 were also high. In five patients who underwent drainage of cysts after birth, systemic inflammation could not be completely suppressed before curative surgery.. Interleukin 6 and interleukin 8 play important roles in the inflammatory response syndrome associated with meconium peritonitis, and drainage of cystic fluid did not completely suppress this inflammation. To lessen the high morbidity of meconium peritonitis, efforts should be made to suppress the inflammatory response using new treatment strategies, such as administration of steroids or anti-cytokine therapy to supplement cystic drainage.

Topics: Ascites; C-Reactive Protein; Chemokines; Cyst Fluid; Cytokines; Drainage; Fatal Outcome; Female; Fetal Diseases; Hernia, Diaphragmatic; Humans; Infant, Newborn; Interleukin-6; Interleukin-8; Intestinal Perforation; Male; Meconium; Peritonitis; Prognosis; Syndrome

Topics: Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Testicular Hydrocele; Treatment Outcome

Newborn surgery for meconium peritonitis (MP) is sometimes very difficult owing to severe adhesions and bleeding. The aim of this study was to reveal the benefit of primary anastomosis (PA) for MP by comparing PA with multistep operations (MO).. We retrospectively reviewed 38 patients with MP who underwent surgery in our institution from 1983 to 2009. From 1983 to 2000, we essentially used MO. After 2001, we used PA with the exception of 1 patient. We performed MO on 20 patients (group A) and PA on 18 patients (group B).. Mortality was 4 in 20 in group A and 1 in 18 in group B. Three patients in group A and 2 in group B required reoperation because of complications. After 2001, 14 of 16 patients underwent PA. Of the 2 patients for whom PA could not be performed, one was postresuscitation from cardiopulmonary arrest and the other was an extremely low-birth-weight infant. The only mortality among the patients who underwent PA occurred in a very low-birth-weight infant who died from intraoperative hepatic hemorrhage.. PA can be performed for almost all patients with MP except for extremely low-birth-weight infants.

Topics: Anastomosis, Surgical; Contraindications; Cysts; Disease Management; Drainage; Humans; Ileostomy; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Atresia; Intestinal Perforation; Intestinal Volvulus; Intussusception; Jejunostomy; Meconium; Peritonitis; Postoperative Complications; Reoperation; Retrospective Studies; Ultrasonography, Prenatal

Ochrobactrum anthropi is a non-fermenting gram-negative rod that was identified as a pathogenic microorganism during the past decade. O. anthropi is extensively distributed in the environment, and has been found in hospital and environmental water sources. O. anthropi infection is rare in childhood. We report a case of O. anthropi bacteremia in a preterm infant with a peritoneal lavage catheter and meconium peritonitis.

Topics: Adult; Bacteremia; Catheters, Indwelling; Fatal Outcome; Female; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Perforation; Meconium; Ochrobactrum anthropi; Peritoneal Lavage; Peritonitis; Pregnancy

Meconium peritonitis is a sterile chemical peritonitis resulting from intestinal perforation in-utero. We present a preterm male neonate weighing 1820 g in whom foetal meconium peritonitis was diagnosed by antenatal utrasonogram. Examination of the newborn in the immediate postnatal period revealed a firm lump of size 5 x 3 cm in the right lumbar and umbilical area. Rest of the abdomen was normal without any clinical evidence of intestinal obstruction. X-ray of abdomen done at 3 hours of life showed a cystic mass with calcified margin. Ultrasonography of abdomen ruled out any definite cause of intestinal obstruction and perforation. He was kept on conservative management. At 11 hours of life the neonate passed a small sticky white mucus plug per rectum followed by black colored meconium of normal consistency 2 hours later. The bowel habit remained regular thereafter. Screening for intrauterine infections and cystic fibrosis was negative. He is under regular follow-up and is now 6 months old with normal bowel habit. A lump of size 2 x 2 cm is still palpable and a small calcified mass is persistent in x-ray. Role of an intestinal mucus plug as the potential factor for intestinal obstruction and subsequent perforation has been highlighted in the present case.

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritonitis; Premature Birth; Treatment Outcome; Ultrasonography

A case of meconium periorchitis detected by fetal MRI and misdiagnosed during pregnancy as inguinoscrotal hernia is reported for the first time. A full-term black boy presented at birth with an asymptomatic, 'stony-hard', scrotal mass suggestive of an in utero testicular torsion or testicular/paratesticular tumor. Early surgical treatment resulted in the removal of paratesticular yellowish amorphous material. Histology was consistent with the diagnosis of meconium periorchitis, a rare and benign condition resulting from healed intrauterine bowel perforation.

Topics: Cysts; Diagnosis, Differential; Female; Hernia, Inguinal; Humans; Infant, Newborn; Intestinal Perforation; Magnetic Resonance Imaging; Male; Meconium; Orchitis; Pregnancy; Prenatal Diagnosis; Scrotum

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.. 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.. 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%.. 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.

Topics: Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Treatment Outcome; Ultrasonography, Prenatal

Meconium peritonitis results from antenatal perforation of the gastrointestinal tract; it presents as gastrointestinal obstruction, intraabdominal masses, or calcification. The presentation with passage of meconium per vagina secondary to meconium peritonitis is rare. We describe the radiologic and surgical findings in a neonate who had passage of meconium per vagina secondary to ileal atresia and meconium peritonitis. Initial clinical and radiologic examination suggested rectal atresia with an associated rectovaginal fistula, although subsequently, this was not the case. Possible explanations for the passage of meconium per vagina include decompression of a meconium cyst via the left fallopian tube or direct perforation of a collection into the vagina from the peritoneal cavity.

Topics: Abnormalities, Multiple; Anastomosis, Surgical; Digestive System Abnormalities; Digestive System Surgical Procedures; Female; Follow-Up Studies; Humans; Ileum; Infant, Newborn; Intensive Care Units, Neonatal; Intestinal Perforation; Laparotomy; Meconium; Peritonitis; Pregnancy; Risk Assessment; Treatment Outcome; Ultrasonography, Prenatal; Uterus

Topics: Cystic Fibrosis; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Orchitis; Pregnancy; Testicular Hydrocele; Ultrasonography, Prenatal

Topics: Anal Canal; Diagnosis, Differential; Enterocolitis, Necrotizing; Humans; Hyperkalemia; Infant, Newborn; Intestinal Perforation; Male; Meconium; Rectum

Meconium peritonitis is a sterile chemical peritonitis resulting from intrauterine bowel perforation. With the development of neonatal care, the prognosis of meconium peritonitis improved much. We report our clinical experience.. The medical records of patients with meconium peritonitis admitted to the Asan Medical Center from June 1989 to July 2006 were retrospectively reviewed.. Of 41 patients (17 males, 24 females), 38 (92.7%) were suspected to suffer from meconium peritonitis prenatally, at a median gestational age of 32 weeks (range, 21-40 weeks). The most common prenatal sonographic finding was fetal ascites followed by dilated bowel. Ten patients were managed conservatively, but 31 patients underwent operations including resection and anastomosis (22), drainage procedure (4), ileostomy (3) and primary repair (2). The operative 31 cases comprised generalized (16), fibroadhesive (10), and cystic types (5). The main causes were intestinal atresia and idiopathic bowel perforation. The mortality rate was 2.4%, and the morbidity rate was 34.1%.. Good survival rate was achieved. But there was rather high morbidity. More gentle and delicate approach should be done to lower the morbidity.

Topics: Female; Fetal Diseases; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intestinal Perforation; Laparotomy; Male; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Treatment Outcome; Ultrasonography

Topics: Humans; Iatrogenic Disease; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pneumoperitoneum; Rectum

Meconium pseudocyst results from a loculated inflammation occurring in response to spillage of meconium into the peritoneal cavity after a bowel perforation. Certain cystic lesions, such as abscesses and dermoid and epidermoid cysts, are known to show reduced water diffusion on DWI. MRI has recently become a valuable adjunct to ultrasonography for fetal gastrointestinal anomalies. Complementary to ultrasonography, prenatal MRI can help further characterize the lesion and can clearly demonstrate the anatomical relationship between the lesion and adjacent organs. We report a case of meconium pseudocyst that was prenatally imaged with ultrasonography and MRI, postnatally complicated by pneumoperitoneum, and proved by postnatal surgery and histopathology. We emphasize the MRI of the pseudocyst, particularly T1-weighted and diffusion-weighted imaging.

Topics: Adult; Cysts; Female; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Magnetic Resonance Imaging; Male; Meconium; Pneumoperitoneum; Pregnancy; Prenatal Diagnosis; Ultrasonography

The transverse colon is an exceptional location of intestinal duplication. Perforated duplications are rarely described in neonates. Meconium peritonitis (MP) can originate from prenatal perforated intestinal duplication. The authors report a case of a baby girl with prenatal diagnosis of MP. Rapid worsening of clinical aspects at birth and the presence of a pneumoperitoneum on systematic abdominal plain radiographs led to urgent surgery on the 1st day of life. Laparotomy showed a perforated necrotizing tubular duplication of the transverse colon. Removal of the duplication followed by limited segmental colonic resection and double colostomy were carried out. Follow-up was uneventful.

Topics: Colon; Colonic Diseases; Female; Humans; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

An isolated fetal ascites is a rare ultrasonographic finding. It is commonly diagnosed in association with fetal genitourinary or gastrointestinal conditions, mainly bowel obstruction. We present the sonographic features and neonatal outcome of a fetus with a large bowel obstruction, perforation and subsequent development of meconium peritonitis, prenatally diagnosed as isolated fetal ascites. A colonic atresia should be also included in the differential diagnosis of isolated fetal ascites.

Topics: Adult; Ascites; Colectomy; Colon; Colostomy; Female; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Topics: Anastomosis, Surgical; Calcinosis; Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Radiography; Ultrasonography

Meconium obstruction of prematurity is a distinct clinical condition that occurs in very low birth weight infants, predisposing them to intestinal perforation and a prolonged hospitalization if not diagnosed and treated promptly. We report a series of 21 infants, including 2 detailed case reports, whose clinical course is indicative of meconium obstruction of prematurity. Specific risk factors are identified along with descriptions of clinical and radiologic findings, disease course, treatment, and outcome. Meconium obstruction of prematurity was more common in infants with a maternal history of pregnancy-induced or chronic hypertension, suggesting the possibility of decreased intestinal perfusion prenatally. Inspissated meconium was located most frequently in the distal ileum, making this disease process difficult to treat. Gastrografin enemas were safe, diagnostic, and therapeutic. Delay in diagnosis and treatment was associated with perforation and delay in institution of enteral feeds.

Topics: Diagnostic Errors; Enema; Humans; Ileus; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Small for Gestational Age; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Radiography; Risk Factors

About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery.

Topics: Contrast Media; Cystic Fibrosis; Enema; Female; Humans; Ileus; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intestinal Volvulus; Intestine, Small; Meconium; Radiography, Abdominal; Ultrasonography, Interventional

Topics: Acetylcysteine; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Intussusception; Meconium; Risk Factors

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).. 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.. 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.. 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.

Topics: Adult; Cysts; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Treatment Outcome; Ultrasonography, Prenatal

We present two cases of fetal meconium peritonitis in a single and twin pregnancy, respectively. The first case diagnosis was made at 30 weeks and was confirmed after delivery of the twins by cesarean section at 37 weeks. The second case diagnosis was made at 31 week and was confirmed at 37 weeks. Meconium peritonitis is a rare prenatal complication that results from intrauterine perforation of small bowel with spillage of sterile meconium into peritoneal cavity. We now report two cases of meconium peritonitis diagnosed at 30 and 31 weeks gestation.

Topics: Adult; Diagnosis, Differential; Female; Fertilization in Vitro; Fetal Diseases; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Jejunal Diseases; Male; Meconium; Peritonitis; Pregnancy; Pregnancy Trimester, Third; Pregnancy, Multiple; Twins; Ultrasonography, Prenatal

Meconium peritonitis most often is associated with congenital intestinal obstruction and meconium ileus. Uncommonly, other etiologies are identified. Hyperimmunoglobulin E syndrome (Job's syndrome) is a rare genetic disorder that is characterized by recurrent staphylococcal respiratory and skin infections in addition to elevated serum IgE levels. There have been 2 previously reported cases of intestinal complications associated with Job's syndrome. The current case is the third such case and is the first report of meconium peritonitis in a patient with hyperimmunoglobulin E syndrome. The patient presented with a meconium thorax as a result of a concurrent congenital diaphragmatic hernia.

Topics: Cecum; Colonic Diseases; Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Muscle, Smooth; Peritonitis; Pregnancy; Thoracic Diseases

This report describes our experiences with 5 cases of biliary atresia associated with meconium peritonitis caused by perforation of small bowel atresia.. A review of medical records was undertaken in an effort to recognize cases of biliary atresia associated with meconium peritonitis.. Five patients of 171 with biliary atresia (2.9%) were detected to have meconium peritonitis caused by perforation of small bowel atresia. The biliary atresia was not suspected during the initial operation for meconium peritonitis. Total parenteral nutrition (TPN) made it difficult to make an early differential diagnosis of biliary atresia because of the presence of TPN-associated cholestatic jaundice, and the Roux-en-Y limb used for hepatic portoenterostomy could not be made long enough to prevent cholangitis caused by preexisting short bowel. The main complications were severe, intractable cholangitis, short bowel syndrome with malnutrition; TPN-associated liver injury; and wound problems. Two patients died of ascending cholangitis, 1 patient of liver failure that was exacerbated by TPN-associated liver injury, and 1 patient is awaiting a liver transplant. Only 1 patient is in good health, being anicteric and showing normal growth and development.. Biliary atresia is evidently closely associated with meconium peritonitis caused by perforation of small bowel atresia. The management of these patients is more difficult than that of patients with the usual form of biliary atresia, because of the necessity for a long period of TPN and the combined short bowel syndrome. The ideal management of these conditions has yet to be determined.

Topics: Biliary Atresia; Female; Humans; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Intestine, Small; Male; Meconium; Peritonitis; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate

Meconium peritonitis occurring in pregnancies following artificial reproductive techniques (ART) is rare. We report the first case of meconium peritonitis following intracytoplasmic sperm injection (ICSI).. A 37-year-old woman attended our in vitro fertilization (IVF) program because her husband suffered from hypospermatogenetic azoospermia due to cancer surgery and radiotherapy. The patient achieved a twin pregnancy through ICSI from testicular sperm extraction at our IVF center. Meconium peritonitis, fetal ascites, polyhydramnios, bowel dilatation, hydrocele and intraabdominal calcification were noted in one of the twins on ultrasound at 30 weeks' gestation. Cesarean section due to breech presentation in labor was performed at 36 weeks' gestation. A normal female and male infant with a distended abdomen were delivered. Emergency laparotomy was performed on the male twin because of dyspnea. A 0.2-cm perforation was found in the terminal ileum. Ileotomy was performed and closed after 27 days.. Prenatal diagnosis of meconium peritonitis is possible through careful ultrasonographic examination, and early surgical intervention and intensive postoperative support are required to improve the prognosis.

Topics: Adult; Breech Presentation; Cesarean Section; Diseases in Twins; Female; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Oligospermia; Peritonitis; Pregnancy; Pregnancy Trimester, Third; Prognosis; Sperm Injections, Intracytoplasmic; Ultrasonography, Prenatal

a) assessment of the relationship between ileus of premature infants and the development of intestinal perforation in premature infants, b) suggestions of an optimal therapeutic procedure. In the study children (n = 50) are included a) with intestinal perforation in conjunction with impaired excretion of meconium (n = 22), b) with an ileus state based on obstruction of the ileum by a viscous meconium treated either surgically or conservatively (n = 28). Surgical treatment involved: a) establishment of a double ileostomy (n = 28), b) insertion of a T drain into the terminal ileum (n = 8), c) removal of meconium from the gut and its primary closure (n = 2). Conservative treatment in 11 children involved irrigography with an liquid contrast substance under X-ray control. The group of children with perforation was compared with the group of children without perforation, risk factors were evaluated by statistical methods. The necessity of ventilation (P = 0.051) and gestation age (P = 0.006) proved to be statistically significant risk factors for the development of perforation. Survival was not influenced by perforation. All 11 children treated conservatively survived, of 39 operated children 26 survived (66.7%). An early start of conservative treatment of ileus of premature infants reduces markedly the risk of intestinal perforation and can thus influence the survival of low birth weight neonates.

Topics: Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Risk Factors

A newborn was referred to our hospital because of poor feeding and abdominal distension and was found to have pneumoperitoneum on abdominal x-ray. At operation there was free intraperitoneal air with no free fluid in the peritoneal cavity. In addition there was free air and meconium retroperitoneally on the left side but there was no evidence of gastrointestinal perforation. This case is rare and unique in that no demonstrable cause for the free air and free meconium could be demonstrated.

Topics: Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Pneumoperitoneum

A case of twin-to-twin transfusion syndrome with intrauterine death of one twin and meconium peritonitis and intravascular disseminated coagulation in the other twin is reported. Meconium peritonitis follows to bowel perforation, caused by segmental severe hypoplasia of muscular layer. The Authors suggest that this structural alteration of bowel wall could be an expression of inequal distribution of some cells between the two twins, during embrional development.

Topics: Adult; Colon; Colonic Diseases; Diseases in Twins; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Fetal Death; Fetal Diseases; Fetofetal Transfusion; Hemoperitoneum; Humans; Ileal Diseases; Ileum; Immunoenzyme Techniques; Infant, Newborn; Intestinal Perforation; Meconium; Muscle, Smooth; Peritonitis; Polyhydramnios; Postoperative Complications; Pregnancy; Twins, Monozygotic

We report sibs (a brother and a sister) who presented prenatally with ultrasound findings of meconium peritonitis and postnatally were found to have perforation of the terminal ileum. The sister presented with fetal ultrasound findings of severe ascites and peritoneal calcifications. She had no prenatal intervention and was born at 38 weeks' gestation. Laparatomy revealed perforation of the terminal ileum with meconium peritonitis. Her post-surgical course was uncomplicated and at 30 months of age her growth and development are normal. Her brother presented prenatally with signs of meconium peritonitis including severe ascites and peritoneal calcifications. Prenatal aspiration of the ascitic fluid was performed and unlike his sister he was born prematurely, was operated on at 8 days, and developed bronchopulmonary dysplasia. He is currently 1 year old and has normal growth and development. The aetiology of the ileal perforation is not known. There were no findings suggesting connective tissue disorder and the aetiology of the intestinal perforation is not known. The occurrence of the same rare abnormality in sibs of different sexes points towards an autosomal recessive disorder.

Topics: Adult; Ascites; Calcinosis; Female; Humans; Intestinal Perforation; Male; Meconium; Peritoneal Diseases; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Topics: Abdomen; Calcinosis; Female; Foreign Bodies; Hernia, Inguinal; Humans; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Physical Examination; Treatment Outcome; Ultrasonography; Ureter; Vulva

We report the first case of legionella infection in pregnancy complicated by sepsis and hemodynamic compromise. Legionnaires' disease is rarely found in pregnancy, possibly because subacute infections may often be overlooked and empiric therapy of pneumonia in pregnancy may be curative without definitive etiologic diagnosis.

Topics: Adult; Female; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Legionnaires' Disease; Male; Meconium; Pregnancy; Pregnancy Complications, Infectious; Shock, Septic

Topics: Adult; Biomarkers; C-Reactive Protein; CA-125 Antigen; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Of 36 neonates with meconium ileus secondary to cystic fibrosis treated over a 10-year period, twenty-one (58%) had simple uncomplicated disease while fifteen (42%) had complications which included perforation (5), volvulus (6) and atresia (5). Gastrografin enema was employed in 20 infants with relief of obstruction in 8 (40%). Operative procedures consisted of resection and primary anastomosis in seventeen patients, stomas were fashioned in six, three had an enterotomy with irrigation only and two had Bishop-Koop enterostomy. Post-operative complications developed in 5 (18%) of these 28 patients. The overall survival rate was 97%. The one death occurred in an infant with short bowel syndrome, patent ductus arteriosus, hydrocephalus and pulmonary damage. There were eight additional patients who had meconium obstruction in the absence of cystic fibrosis.

Topics: Cystic Fibrosis; Diatrizoate Meglumine; Enema; Enterostomy; Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; London; Male; Meconium; Retrospective Studies; Survival Rate

An unusual case of meconium peritonitis is reported. A neonate presented with a huge multiseptate effusion in the peritoneal cavity in relation with a small bowel perforation. No calcification was visible. Such a presentation cannot be included in one of the classical types of meconium peritonitis. It could be due to a bowel perforation occurring immediately before birth and could therefore be related to a mixed fibroadhesive and generalized form.

Topics: Diagnosis, Differential; Female; Humans; Infant, Newborn; Intestinal Perforation; Intestine, Small; Magnetic Resonance Imaging; Meconium; Peritoneal Neoplasms; Peritonitis; Ultrasonography

Markedly premature infants may present with intestinal obstruction and perforation secondary to inspissated meconium in the absence of cystic fibrosis. Between 1990 and 1994, 13 patients were treated for intestinal obstruction secondary to inspissated meconium. The average birth weight was 760 g. Prenatal and postnatal risk factors were identified, and included intrauterine growth retardation, maternal hypertension, prolonged administration of tocolytics, patent ductus arteriosus, hyaline membrane disease, and intraventricular hemorrhage. Stooling was absent or infrequent during the first 2 weeks of life. Surgical presentation consisted of distension and/or perforation between days 2 and 17 of life. Twelve patients required operative intervention. Findings invariably included one or more obstructing meconium plugs with proximal distension and frequent necrosis of the dilated segments. Surgical options consisted of resection or enterotomy, accompanied by primary closure or by distal irrigation and exteriorization. Irrigation led to iatrogenic bowel injury in two patients. One patient was managed successfully with oral and rectal gastrograffin and oral acetylcysteine. Ten patients were discharged, all of whom had normal stooling patterns and tested negatively for cystic fibrosis. Three patients died, two from the primary disease. The markedly premature infant is at risk for obstruction and eventual perforation secondary to meconium plugs, presumably formed in conjunction with intestinal dysmotility. Prompt diagnosis and timely intervention require a high index of suspicion, attention to stooling patterns and abdominal examinations, and screening radiographs when indicated.

Topics: California; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Meconium; Risk Factors; Survival Rate; Time Factors

The authors reviewed their experience with meconium peritonitis (MP) diagnosed in utero to define criteria for prenatal and postnatal management. Prenatal diagnosis was made by identifying abdominal calcification on serial ultrasound examinations in nine fetuses, between 18 and 37 weeks' gestation. Cases without associated bowel abnormalities were considered "simple MP" and those with bowel abnormalities were considered "complex MP." Five cases of simple MP were identified at 18, 23, 30, 34, and 37 weeks' gestation. These five fetuses were delivered at term and had normal abdominal examinations. Abdominal radiographs were obtained in three showing normal bowel gas patterns, and abdominal calcifications in only two. All five patients were fed uneventfully. Four cases of complex MP were identified at 26, 26, 31, and 31 weeks' gestation. All four fetuses had dilated loops of bowel. Two of the four had meconium cysts, one of which was associated with ascites and the other with polyhydramnios. Shortly after birth both infants with meconium cysts required ileal resection and ileostomy for ileal atresia and ileal perforation, respectively. The remaining two infants had no evidence of dilated bowel, meconium cyst, or ascites on postnatal radiograph and were fed uneventfully. These data suggest that only 22% of fetuses with a prenatal diagnosis of MP develop complications that require postnatal operation. Gestational age at diagnosis does not correlate with postnatal outcome. Fetuses with complex MP are at increased risk for postnatal bowel obstruction and perforation.

Topics: Ascites; Calcinosis; Cysts; Dilatation, Pathologic; Female; Fetal Diseases; Follow-Up Studies; Gases; Gestational Age; Humans; Ileal Diseases; Ileum; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestinal Perforation; Intestines; Male; Meconium; Peritonitis; Polyhydramnios; Pregnancy; Pregnancy Outcome; Radiography; Ultrasonography, Prenatal

To determine the practice pattern regarding nonoperative treatment of simple meconium ileus, a survey was sent to directors of 66 pediatric radiology departments in the USA and Canada. Thirty-nine responses were received reporting 1,236 patients. A wide variation of enema techniques and contrast media were used. While the success rate did not correlate with osmolality, mode of administration, catheter size, or perforation rate, there was a significantly higher overall success rate with the use of Gastrografin versus non-Gastrografin (p < 0.00076) and the use of additives such as Tween-80 and Mucomyst versus techniques without additives (p < 0.00001). Perforation did not correlate with success rate, osmolality, or type of contrast medium. The only two instances of rectal perforations were associated with the use of balloon-tip catheter.

Topics: Canada; Contrast Media; Data Collection; Diatrizoate Meglumine; Enema; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Meconium; Practice Patterns, Physicians'; Radiology; Societies, Medical; United States

In nine patients with meconium peritonitis prenatal ultrasonographic findings were correlated with the clinical course and outcome. Ultrasound findings included polyhydramnion (n = 4), ascites (n = 4), disseminated (n = 3) and solitary echogenic areas (n = 1), echopoor cystic areas (n = 3) and echogenic-echopoor solitary areas (n = 1). Intra-abdominal calcifications were found in five patients before delivery. Eight neonates survived and were subsequently followed up, one fetus died in utero. Four of the eight survivors required surgery, namely for meconium ileus (n = 1), perforation secondary to intestinal volvulus (n = 2) and inguinal hernia associated with prenatal rubella infection (n = 1). Three patients were healthy, one patient required drainage of pleural effusion and respirator therapy but recovered without further problems. Cystic fibrosis was diagnosed in the patient with meconium ileus. Postnatal outcome could not be predicted from the prenatal sonographic findings.

Topics: Adult; Calcinosis; Cesarean Section; Cystic Fibrosis; Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Polyhydramnios; Pregnancy; Ultrasonography, Prenatal

We report on a patient with atresia of the colon transversum and a large meconium pseudocyst adherent to the liver. Sonography additionally revealed multiple cystic structures due to intrahepatic meconium masses. Surgical evacuation of the meconium pseudocyst resulted in massive diffuse hemorrhage from the liver which could not be stopped. The child died intraoperatively due to hemorrhagic shock. Histologically the intrahepatic meconium masses were surrounded by various degrees of necrosis and hemorrhage without a well-defined capsule of fibrous granulation tissue.

Topics: Colonic Diseases; Cysts; Fatal Outcome; Humans; Infant, Newborn; Intestinal Perforation; Liver Diseases; Male; Meconium; Peritonitis; Ultrasonography

Topics: Humans; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Tissue Adhesions; Ultrasonography

A case of foetal non-immune hydrops fetalis is presented. A second gravida was referred to our department at 31 weeks' gestation after normal pregnancy course. Sonography revealed marked foetal ascites as well as a polyhydramnion. Prenatal examinations did not yield a safe diagnosis. The foetal ascites was punctured via a pigtail-catheter that was left in the foetal abdomen. This procedure was supposed to facilitate the development of foetal lungs. At 33 weeks' gestation, after spontaneous rupture of membranes, a boy was spontaneously delivered. Postpartal radiography pointed to bowel perforation. Surgery on the first day of life showed a severe meconium peritonitis following a perforation of the ileum. 22 months after this operation, the boy is physically and mentally well developed. Until now, there is no sign of mucoviscidosis. We believe that early diagnosis, the possibility of prenatal therapy and the close collaboration of disciplines made the survival of this child possible.

Topics: Colon; Female; Humans; Hydrops Fetalis; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Neonatal gastrointestinal perforation has been associated with mortality rates of 40% to 70%. Over the past 20 years, 81 infants (46 boys and 35 girls) were treated for a gastrointestinal perforation at this institution. Perforation occurred from birth to 50 days (average, 8.2 days). Etiologies included necrotizing enterocolitis (NEC) (68%), meconium ileus (10%), and idiopathic gastric perforation (7%). Seventy-six infants underwent surgical exploration and five infants, considered too small or too sick to withstand a laparotomy, were treated with peritoneal lavage only. There were 29 deaths, an overall mortality of 36%. Ninety percent of the death occurred in patients with NEC, while all patients with gastric perforations survived. There has not been a significant improvement in survival in recent years, partly because of an increase in the proportion of NEC-related perforations. However, there is a narrowing of the mortality gap between low birth weight and normal weight infants. As the risk inherent to laparotomy in neonates is decreasing, other factors, such as the underlying etiology or the site of perforation, play a more important prognostic role.

Topics: Enterocolitis, Pseudomembranous; Female; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Retrospective Studies; Stomach Rupture; Survival Rate

Meconium peritonitis is a chemical peritonitis usually resulting from antenatal bowel rupture. Prenatal ultrasound findings include ascites, intraabdominal masses, bowel dilatation and the development of intraabdominal calcifications [1-5]. The most common bowel disorders which lead to meconium peritonitis in utero are those resulting in bowel obstruction and perforation, such as small bowel atresias, volvulus and meconium ileus [1-5]. Meconium ileus is associated with cystic fibrosis in most cases, although extraluminal abdominal calcifications are usually scarce in cases of cystic fibrosis [1, 6]. Postnatal outcome for infants with meconium peritonitis depends on the etiology for bowel rupture and underlying disease.

Topics: Ascites; Cystic Fibrosis; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

The study of 53 patients with neonatal meconium peritonitis (MP) over a twenty-two year-period, the largest surgically-treated series at a single centre, is presented. Three different types of MP were established: Generalized, Localized and Cystic. Prognosis and surgical techniques to be used were determined by each MP type. The following survival rates achieved: for Generalized MP, 70% with "one stage" and 89% with "two stage"; for Localized MP, 80% with "one stage" and 100% with "two stage" and for Cystic MP, 57% with "two stage". The overall survival rate was 77%, rising to 85% in the last fifteen years, probably due to the advent of parenteral nutrition and advances in neonatal intensive care.

Topics: Cystic Fibrosis; Female; Humans; Infant, Newborn; Intensive Care, Neonatal; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Prognosis; Spain

Topics: Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy

Topics: Adult; Bone Neoplasms; Cysts; Diagnosis, Differential; Diagnostic Errors; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Meconium; Pregnancy; Sacrococcygeal Region; Teratoma

Spontaneous, focal gastrointestinal perforation occurred in six very low birth weight infants. The first recognized clinical sign of perforation in five of the six infants was striking blue-black discoloration of the abdominal wall. In all cases the clinical and radiographic presentations, as well as the histologic findings, were distinct from those associated with necrotizing enterocolitis. All 4 infants who underwent exploratory laparotomy and repair had excellent surgical outcomes.

Topics: Colonic Diseases; Female; Humans; Ileal Diseases; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Intestinal Perforation; Male; Meconium; Peritonitis

Antenatal appendicular perforation leading to localized meconium peritonitis and intestinal obstruction is reported in a premature neonate. The baby was successfully treated by a limited ileocaecal resection.

Topics: Appendicitis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Rupture, Spontaneous

In this case report the cystic form of meconium peritonitis is presented. The aetiology and differential diagnosis of this rare entity are discussed.

Topics: Cysts; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Ultrasonography

Over the last 11 years, 22 neonates were treated with water-soluble contrast enemas to relieve the obstruction of meconium ileus. Fifteen babies had a gestational age of at least 36 weeks, and 16 weighed more than 2,500 g. All presented with clinical findings of a bowel obstruction, confirmed by roentgenograms, and each eventually had high sweat chloride levels. Each neonate had from 1 to 4 water-soluble contrast enemas administered slowly by syringe over 15 to 30 minutes. Eight enemas were successful in relieving the obstruction, four newborns requiring only one enema. Fourteen were unsuccessful, three having more than one enema. Seven of these 14 had intraabdominal pathology that would have required surgery. In five babies the bowel was perforated by the enema, the colon in three, and terminal ileum in two. These perforations were all immediately recognized during the course of the enema and operated on forthwith; a stoma was made in four cases. Only one of these five babies would have required an operation because of a volvulus. There were no fluid or electrolyte disturbances caused by the contrast material, and none of the babies with perforations died. Although this enema technique was successful in one third of cases, and despite the fact that perforations ensued in one quarter of cases, the procedure still seems warranted if the following precautions are taken: establishment of proper temperature, fluid, and electrolyte balance; the radiologist is not rushed, is extremely gentle, willing to repeat the study until no further progress is evident; the surgeon is available for an immediate laparotomy should a perforation occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Diatrizoate Meglumine; Enema; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Meconium; Radiography

Topics: Ambulatory Care; Catheters, Indwelling; Child; Child, Preschool; Home Nursing; Humans; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; Meconium; Parenteral Nutrition; Parenteral Nutrition, Total; Short Bowel Syndrome

We describe three children with surgically confirmed meconium peritonitis. All had abnormal prenatal ultrasonographic examinations. The first child showed multiple cysts, the second had hydrops fetalis, and the third had dilated bowel loops. A polyhydramnion was common to all three cases. Of the two children who died, one had cystic fibrosis. It is remarkable that the ultrasonographic findings were different in the three children.

Topics: Colon; Female; Follow-Up Studies; Humans; Ileum; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Ultrasonography

Topics: Adult; Ascitic Fluid; Female; Humans; Infant, Newborn; Intestinal Perforation; Jejunum; Male; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Ultrasonography

According to the difficulties in communication with babies and very young children there often are problems in the early diagnosis of abdominal pain or symptoms. This is demonstrated in the example of appendicitis in children and meconium peritonitis in the newborns. The possibilities of pain measuring in newborn or preterm babies are shortly discussed.

Topics: Abdomen; Abdomen, Acute; Appendicitis; Child; Child, Preschool; Diagnosis, Differential; Humans; Infant; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis

Meconium pleuritis developed in a neonate with a perforation of the sigmoid colon, through a diaphragmatic defect. The meconium released in the abdomen communicated with the right pleural space. The association of these defects is unusual, and the cytologic diagnosis of meconium pleuritis has not been previously reported.

Topics: Colonic Diseases; Cytodiagnosis; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pleurisy; Radiography

The etiology of bowel perforations leading to meconium peritonitis was investigated in an attempt to explain the occurrence of such perforations in the absence of primary intestinal obstruction. Bowel specimens from 22 patients who had presented with meconium peritonitis during a 15-year period, as well as specimens from five patients with intestinal atresia without associated meconium peritonitis, were re-evaluated microscopically. An extensive review of the literature concerning meconium peritonitis, involving 1,084 patients, was compared with the results of a retrospective study of 69 patients from The Netherlands. In approximately 50 per cent of these cases there was no detectable primary cause of the bowel perforation. The pathologic findings, in combination with earlier experimental studies, indicate that vascular insufficiency may result in bowel wall perforation without prior intestinal obstruction. It is suggested that temporary decrease of mesenteric blood flow could lead to intestinal atresia and/or meconium peritonitis.

Topics: Birth Weight; Cystic Fibrosis; Gestational Age; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Intestines; Meconium; Peritonitis; Splanchnic Circulation

Topics: Cysts; Humans; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis

Meconium peritonitis being a rare anomaly, it is difficult to find the factors that determine the prognosis. In spite of the high mortality, this aspect has hardly ever been studied. A retrospective study of 69 patients from the Netherlands over a 15 year period, revealed that a patient with pneumoperitoneum and a generalized type of meconium peritonitis has a relatively favourable prognosis. Despite a more optimistic outlook expressed in recent publications, an overview of the world literature involving 1084 patients shows that the mortality for this disease has not dropped in the past 15 years and still amounts to 55%.

Topics: Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Postoperative Complications; Pregnancy; Prognosis; Retrospective Studies

Meconium peritonitis occasionally occurs as a localized, encysted collection of meconium ranging from a few centimeters in size to huge cysts occupying most of the abdominal cavity. The cyst wall consists of fibrous granulation tissue and the cyst may contain only meconium or may also encase loops of bowel. Gas within the cyst indicates persistent communication between the perforated bowel and the cyst cavity; if the perforation seals over in utero the cyst remains gasless. Calcification is a variable finding. Sonography in two neonates with cystic meconium peritonitis showed well-defined, echogenic masses, one of which contained calcifications and was detected in utero.

Topics: Adolescent; Cysts; Female; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography

The prenatal diagnosis of fetal bowel obstruction with perforation and meconium peritonitis is described. Characteristic ultrasound findings include polyhydramnios, fetal ascites, and echogenic calcific foci with acoustical shadowing.

Topics: Adult; Calcinosis; Female; Fetal Diseases; Humans; Intestinal Perforation; Male; Meconium; Peritonitis; Polyhydramnios; Pregnancy; Ultrasonography

Topics: Abdomen; Adult; Ascites; Diagnosis, Differential; Erythroblastosis, Fetal; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography

Topics: Female; Humans; Infant, Newborn; Infant, Postmature; Intestinal Perforation; Meconium; Pelvis; Rectal Diseases; Retroperitoneal Space; Ultrasonography

A case of meconium thorax resulting from spontaneous perforation of the colon associated with a right Bochdalek's foramen, without herniation, is presented. The baby had immediate respiratory distress postpartum resulting from the meconium in the pleural cavity. No fetal distress was detected, in spite of electrode monitoring in labor, to account for the colonic perforation.

Topics: Colonic Diseases; Female; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Pregnancy; Respiratory Distress Syndrome, Newborn; Thoracic Diseases

In 20 years the authors have met with 115 cases of meconium peritonitis (MP). The high incidence in China is shown. In all cases there were intraabdominal calcifications. There were no cases of fibrocystic disease. The authors classify 3 types: 1. Neonatal obstructive type 41 cases. 2. Free perforation with: Free pneumoperitoneum 15 cases. Localized pneumoperitoneum 23 cases. 3. No signs or symptoms, with potential intestinal obstruction 23 cases. The series shows a low incidence of atresia. The authors suggest necrotizing enterocolitis as a cause because of the high incidence of stenosis. Three prenatally diagnosed cases are discussed. All had hydramnios and fetal abdominal calcifications. Two of these were confirmed after birth. The mortality is high (42.6%). Abdominal x-ray in all cases with polyhydramnios may lead to a positive diagnosis of MP.

Topics: Abdomen; Adult; Calcinosis; China; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pneumoperitoneum; Polyhydramnios; Pregnancy; Prenatal Diagnosis

Topics: Ascites; Calcinosis; Female; Fetal Diseases; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Ultrasonography

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Spectrophotometry

Topics: Cysts; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Radiography, Abdominal

Topics: Adult; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Intestine, Small; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Rupture, Spontaneous; Ultrasonography

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritonitis; Sigmoid Diseases

Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritonitis

In chick embryos we studied the effect on intestinal development of an experimentally induced perforation and a vascular lesion performed at an early developmental stage. The results show that an intestinal perforation will heal, but may lead to intestinal atresia with microscopic signs of meconium peritonitis. Conversely, a vascular lesion induced at an early stage of development does not lead to intestinal atresia, while a vascular lesion performed at a late stage of development does result in intestinal atresia, but without any signs of meconium peritonitis.

Topics: Animals; Chick Embryo; Intestinal Atresia; Intestinal Perforation; Intestines; Meconium; Peritonitis; Splanchnic Circulation; Wound Healing

Topics: Adult; Ascites; Calcinosis; Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Ultrasonography

A newborn infant, who had suffered intrauterine perforation and had developed peritoneal calcification, showed no sign of pneumoperitoneum on the first radiograph taken 3 hours after delivery. At that time air was present in the stomach only. Subsequently pneumoperitoneum developed as air passed down the gut to the point of perforation. Thus, the absence of pneumoperitoneum on a radiograph taken very early in life does not exclude an intestinal perforation.

Topics: Colonic Diseases; Female; Fetal Diseases; Humans; Infant; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pneumoperitoneum; Pregnancy; Radiography

Topics: Humans; Ileal Diseases; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritonitis; Prognosis; Radiography

Although NSLCS has been considered to have a benign course, we have described an infant who had intrauterine intestinal perforation and meconium peritonitis associated with the NSLCS. Infants of diabetic mothers who are stillborn or who develop abdominal distention shortly after delivery should be suspected of having this complication of NSLCS. This disorder must also be considered in the differential diagnosis of infants who present with meconium peritonitis.

Topics: Colonic Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Meconium; Peritonitis; Syndrome

Topics: Adult; Amniotic Fluid; Bilirubin; Colon; Diseases in Twins; Erythroblastosis, Fetal; Female; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Meconium; Peritonitis

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritonitis; Radiography

Topics: Female; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Rupture, Spontaneous

Apparently spontaneous neonatal intestinal perforation may be difficult to diagnose if the condition is not kept in mind. It may present with free perforation or with the late effects of meconium peritonitis. Five cases are described. There is a high mortality associated with bacterial peritonitis, and the importance of early diagnosis and energetic resuscitation is underlined.

Topics: Colonic Diseases; Female; Humans; Ileum; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Jejunum; Male; Meconium; Peritonitis; Rupture, Spontaneous; Stomach Rupture

Topics: Calcinosis; Constipation; Female; Fetal Diseases; Gastrointestinal Motility; Humans; Infant; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Radiography, Abdominal; Time Factors; Tissue Adhesions; Vomiting

Topics: Catheterization; Colon; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Infusions, Parenteral; Intestinal Perforation; Labor Presentation; Laparotomy; Meconium; Pregnancy; Twins

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Meconium; Peritonitis

Topics: Calcinosis; Female; Fetal Diseases; Hernia; Humans; Infant; Intestinal Obstruction; Intestinal Perforation; Jejunum; Male; Meconium; Peritonitis; Pregnancy; Radiography; Tissue Adhesions

Topics: Child, Preschool; Cysts; Female; Fetal Diseases; Humans; Ileum; Infant, Newborn; Intestinal Diseases; Intestinal Perforation; Meconium; Pregnancy; Radiography, Abdominal

Topics: Appendicitis; Child; Child, Preschool; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intussusception; Meckel Diverticulum; Meconium; Pancreatitis; Peptic Ulcer Perforation; Peritonitis; Radiography

Topics: Duodenum; Emergencies; Esophageal Atresia; Female; Gastrointestinal Diseases; Hernia, Diaphragmatic; Hernia, Inguinal; Hernia, Umbilical; Hernia, Ventral; Hernias, Diaphragmatic, Congenital; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; Jejunum; Meconium; Pneumothorax; Pregnancy; Pyloric Stenosis; Renal Veins; Rupture; Stomach Diseases; Thrombophlebitis

Topics: Acute Disease; Autopsy; Chronic Disease; Colon, Sigmoid; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Muscle, Smooth; Peritonitis; Pregnancy; Tissue Adhesions

Topics: Colonic Diseases; Cystic Fibrosis; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Radiography

Topics: Adult; Female; Fetal Death; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Intestine, Small; Meconium; Obstetric Labor Complications; Peritonitis; Pregnancy

Topics: Duodenal Diseases; Duodenal Ulcer; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Intussusception; Laparotomy; Meckel Diverticulum; Meconium; Methods; Peritonitis; Suture Techniques; Time Factors

Topics: Ampulla of Vater; Cystic Fibrosis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Peritonitis; Polyhydramnios; Pregnancy; Radiography

Topics: Abdomen; Adult; Female; Fistula; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Scrotum

Topics: Abdomen, Acute; Collateral Circulation; Cystic Fibrosis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intestines; Male; Meconium; Peritoneum; Peritonitis; Pneumoperitoneum; Pregnancy; Radiography, Abdominal; Sepsis; Stomach Rupture

Topics: Abdominal Muscles; Anus, Imperforate; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intestines; Male; Meconium; Megacolon

Topics: Cholestasis; Cystic Fibrosis; Esophageal Perforation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Polyhydramnios; Pregnancy; Prognosis

Topics: Abdomen, Acute; Child, Preschool; Cystic Fibrosis; Duodenal Diseases; Esophagus; Female; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meckel Diverticulum; Meconium; Posture; Pyloric Stenosis; Radiography

Topics: Colostomy; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Jejunum; Male; Meconium; Peptic Ulcer Perforation; Peritonitis; Pneumoperitoneum; Radiography; Sepsis; Stomach

Topics: Anti-Bacterial Agents; Colitis; Enema; Female; Hernia, Umbilical; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Peritonitis; Pneumoperitoneum

Topics: Cysts; Female; Fetal Diseases; Humans; Hyperbilirubinemia; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Meconium; Obstetric Labor Complications; Perineum; Peritonitis; Pregnancy

Topics: Colonic Diseases; Diagnosis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Laparotomy; Meconium; Postoperative Care; Radiography; Surgical Procedures, Operative

Topics: Fetal Diseases; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Meckel Diverticulum; Meconium; Peritonitis; Surgical Procedures, Operative

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis

Topics: Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Postoperative Care; Radiography; Surgical Procedures, Operative

Topics: Calcinosis; Congenital Abnormalities; Cystic Fibrosis; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Surgical Procedures, Operative

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Liver Diseases; Meconium; Megacolon; Peritonitis; Pseudomonas Infections; Radiography; Sepsis

Topics: Acetylcysteine; Cysteine; Cystic Fibrosis; Fetal Diseases; Hernia, Umbilical; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Surgical Procedures, Operative

Topics: Calcinosis; Fetal Diseases; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritoneum; Peritonitis; Scrotum

Topics: Fetal Diseases; Granuloma; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Perforation; Meckel Diverticulum; Meconium; Pathology; Peritonitis

Topics: Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Surgical Procedures, Operative

Topics: Cystic Fibrosis; Fetal Diseases; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Meconium; Peritonitis; Survivors

Topics: Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Intestines; Meconium; Peritonitis