morphine and Peritoneal-Diseases

Prenatal ultrasonography (US) in a 39 year-old woman revealed massive fetal ascites. A fetal abdomino-amniotic shunting procedure was performed. Subsequently, plain radiographs demonstrated diffuse gaseous distention of the bowel and multiple punctate calcifications in the left upper abdomen. Postnatal US examination showed multiple echogenic foci in the liver and the left upper abdomen, bowel wall thickening in the right-sided abdomen, and undescended testes. There was no intra-abdominal free air or loculated fluid collections. Medical management was instituted secondary to the clinical suspicion of omental calcification, necrotizing enterocolitis, and undescended testes. Follow-up US examination showed resolution of portal vein gas and bowel wall thickening. The neonate recovered fully.

Topics: Adult; Calcinosis; Cryptorchidism; Enterocolitis, Necrotizing; Female; Fetal Diseases; Fetal Therapies; Humans; Infant, Newborn; Male; Meconium; Omentum; Peritoneal Diseases; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Meconium peritonitis with pseudocyst formation is rare and can be lethal. We report a newborn infant with antenatal sonographic diagnosis of bowel dilatation and giant meconium pseudocyst. Postnatal presentation included a palpable abdominal mass and abdominal distention. Abdominal X-ray revealed a huge egg-shell calcified mass containing air-fluid level. Postnatal sonography revealed a cystic mass with air-fluid level and acoustic shadows. Computed tomography showed a giant communicating cyst with egg-shell calcification, which compressed the other intestinal loops to the posterior peritoneal cavity. Elective laparotomy was performed, and distal ileal atresia with sealed proximal perforation and a giant meconium pseudocyst were found. Resection of the involved small bowel, including the giant pseudocyst, followed by primary end-to-end anastomosis was performed smoothly. The postoperative course was uneventful. Advances in perinatal intensive care mean that neonates can be operated upon under stable rather than critical conditions, and elective rather than emergency laparotomy, and primary anastomosis of the intestine rather than staged enterostomy can be performed.

Topics: Adult; Cysts; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Infant, Newborn; Laparotomy; Meconium; Peritoneal Diseases; Pregnancy; Pregnancy Complications, Neoplastic; Radiography, Abdominal; Time Factors; Tomography, X-Ray Computed; Ultrasonography, Prenatal

Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.

Topics: Adolescent; Adult; Cysts; Female; Humans; Infant, Newborn; Meconium; Peritoneal Diseases; Peritonitis; Time Factors; Ultrasonography, Prenatal

Topics: Female; Humans; Infant, Newborn; Meconium; Peritoneal Diseases; Vulvar Diseases

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: Adult; Calcinosis; Female; Fetal Diseases; Hernia, Inguinal; Humans; Meconium; Peritoneal Diseases; Peritonitis; Pregnancy; Radiography; Ultrasonography

We present two cases of histologically proven maternal intraperitoneal granulomata following cesarean section delivery. One patient presented during the immediate postpartum period with clinical symptoms consistent with subphrenic abscess. The other patient required operative intervention for a suspected ruptured tubo-ovarian abscess. In both cases, microscopic examination of the tissue obtained at the time of reoperation showed granuloma reaction, lanugo hair, and fetal squamous cells consistent with meconium deposition. The authors conclude that meconium granuloma should enter the differential diagnosis in cesarean section patients with unexplained postoperative pain.

Topics: Adult; Cesarean Section; Female; Foreign-Body Reaction; Granuloma; Humans; Meconium; Pain, Postoperative; Peritoneal Diseases; Pregnancy

Topics: Adult; Cesarean Section; Female; Granuloma; Humans; Meconium; Omentum; Peritoneal Diseases; Pregnancy

Twelve cases of meconium peritonitis were retrospectively reviewed in this study. Five of these patients had cystic fibrosis. Of the patients with cystic fibrosis, intraperitoneal calcifications were present in three (60%) and two (40%) had none. All seven patients (100%) who had meconium peritonitis without cystic fibrosis had abdominal calcifications. These results indicate that the presence of intraperitoneal calcifications does not exclude the diagnosis of cystic fibrosis and that the absence of calcification favors cystic fibrosis. However, a review of the literature indicates the absence of calcification is merely of clue and not definitive as to the etiology of the meconium peritonitis.

Topics: Calcinosis; Cystic Fibrosis; Female; Humans; Infant, Newborn; Male; Meconium; Peritoneal Diseases; Peritonitis

Topics: Abscess; Animals; Calcinosis; Cystic Fibrosis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Peritoneal Diseases; Peritonitis; Radiography; Rats

Two of 15 children who survived neonatal meconium ileus had "meconium ileus equivalent." They were treated with hydration, pancreatic enzyme therapy and antibiotics. One of these children died from pulmonary disease at the time of the bowel obstruction. The survival rate of infants with meconium ileus is steadily improving because of prompt operative intervention, better preoperative and postoperative care and long-term treatment with enzyme supplements and antibiotics. Late intestinal obstruction due to adhesive bands, volvulus, intussusception or "meconium ileus equivalent" may occur in children previously treated for meconium ileus of infancy. The omission of pancreatic enzyme supplementation and the occurrence of respiratory infections are frequently associated with "meconium ileus equivalent."In this series of patients four of the infants treated surgically for neonatal meconium ileus died in the early postoperative period.

Topics: Anti-Bacterial Agents; Child; Cystic Fibrosis; Fetal Diseases; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Intestinal Volvulus; Intussusception; Male; Meconium; Pancreas; Peritoneal Diseases; Postoperative Care; Respiratory Tract Infections; Surgical Procedures, Operative; Survival Rate