Clinical Features and Outcomes of Perinatally Diagnosed Meconium Peritonitis

Eun-Jung Koo; Eunyoung Jung; Soon-Ok Choi; Jin-Gon Bae

doi:10.14734/PN.2017.28.2.29

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Koo, Jung, Choi, and Bae: Clinical Features and Outcomes of Perinatally Diagnosed Meconium Peritonitis

Original Article

Perinatology 2017;28(2):29-34.

Published online: 19 June 2017

DOI: https://doi.org/10.14734/PN.2017.28.2.29

Clinical Features and Outcomes of Perinatally Diagnosed Meconium Peritonitis

Eun-Jung Koo, MD¹, Eunyoung Jung, MD^1,, Soon-Ok Choi, MD, PhD¹, Jin-Gon Bae, MD²

¹Department of Pediatric Surgery, Keimyung University Dongsan Medical Center, Daegu,

²Department of Obsterics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea

Correspondence to Eunyoung Jung, MD Department of Pediatric Surgery, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-8091 Fax: +82-53-250-7322 E-mail: eyjung@dsmc.or.kr

Received 1 February 201713 March 2017 Accepted 27 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Meconium peritonitis (MP) is defined as sterile chemical peritonitis, resulting from intrauterine bowel perforation. MP is rare but has high morbidity and mortality in neonates. We aimed to review the treatment and clinical course of MP, and to find out the possible relationship between perinatal parameters and outcomes.

Methods

All patients diagnosed with MP between February 2006 and October 2016 were investigated retrospectively. MP was diagnosed with prenatal ultrasonography and the types of MP were identified intraoperatively. Findings of prenatal ultrasonography, gestational age, gender, birth weight, delivery type, APGAR score, clinical symptoms, causes of MP, mortality and morbidity, and hospital stay were analysed.

Results

Thirteen patients were antenatally diagnosed with MP. Median gestational age was 37 weeks. All patients were diagnosed using prenatal ultrasonography. Calcification was found in 13 patients, bowel dilatation in 8, fetal ascites in 7, polyhydramnios in 6, and pseudocyst in 3. Five were females and 8 were males. Median birth weight was 2,930 g. Symptoms of abdominal distension were reported in 10 patients, bilious vomiting in 2, pneumoperitoneum in 2, and no symptoms and signs of MP in 1. One patient recovered with conservative management and the other 12 patients required surgery. All patients who underwent surgery had underlying pathologic causes; jejunoileal atresia, ileal perforation and transverse colonic perforation. Two cases of mortality occurred.

Conclusion

The mortality patients were haemodynamically unstable and had received preoperative pressor agents and ventilator care. More studies are needed to investigate the correlation between mortality and preoperative vital status.

Keywords: Fetal ultrasonography, Intrauterine bowel perforation, Meconium peritonitis, Prenatal sonography

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Fig. 1

Postnatal images and intraoperative findings (patient 1 in Table 2). (A) Postnatal plain X-ray; space occupying lesion in whole abdomen and bowels were positioned in left upper and lower quadrant. (B) Coronal image of computed tomography; fluid-containing cyst was seen and bowels were shifted to the left side. (C, D) Intraoperative findings; huge meconium cyst containing meconium and white calcification.

Table 1.

Clinical Characteristics of Meconium Peritonitis Patients

Characteristic	N=13
Gender
Male/female	8/5
Gestational age (wks and days)	37 (31⁺¹–39⁺³)
Body weight at birth (g)	2,930 (2,020–4,000)
Delivery type
NSVD/C-sec	3/10
APGAR score
1 min/5 min	7 (1–8)/8 (5–9)
GA of detecting fetal abnormality (wks)	28 (24–35)
Prenatal USG (prenatal diagnosis 13/13, 100%)∗
Intraabdominal calcification	13
Fetal bowel dilatation	8
Ascites	7
Polyhydraminos	6
Meconium cyst	3

Values are presented as number or median (range). Abbreviations: NSVD, normal spontaneous vaginal delivery; C-sec, Caesarean section; GA, gestational age; USG, ultrasonography.

^∗ Overlapped with 2 or more findings.

Table 2.

Characteristics of Patients with Perinatally Diagnosed MP

No.	Gender	GA at prenatal diagnosis	GA at birth (weeks and days)	Birth weight (g)	Prenatal Sonography Scoring∗	Type	Cause of MP	Operative strategy	Survival
1	M	25	37⁺³	3,360	3	C	Jejunal atresia	Enterostomy	Y
2	M	29	35⁺⁶	4,000	3	C	Jejunal atresia	Segmental resection and anastomosis	Y
3	M	27	38⁺³	3,260	1A	C	Ileal atresia	Segmental resection and anastomosis	Y
4	M	24	37⁺⁰	2,930	1A	H
5	M	24	37⁺²	2,930	2	C	Ileal perforation	Enterostomy	Y
6	F	28	33⁺²	2,310	3	C	Ileal atresia	Enterostomy	Y
7	F	32	38⁺⁴	2,840	3	G	Ileal atresia	Enterostomy	Y
8	F	25	38⁺⁶	3,960	1C	G	Jejunal atresia	Segmental resection and anastomosis	Y
9	M	32	38⁺⁰	2,890	2	F^†	Ileal atresia	Segmental resection and anastomosis	Y
10	M	28	31⁺¹	2,020	1A	G	Ileal perforation	Enterostomy	N
11	F	34	35⁺⁴	2,410	2	F^†	Ileal atresia	Enterostomy	Y
12	M	32	38⁺⁴	2,690	2	G	Ileal atresia	Enterostomy	N
13	F	25	39⁺³	3,630	3	C	Transverse colonic perforation	Primary closure	Y

Abbreviations: MP, meconium peritonitis; GA, gestation age; M, male; C, pseudocyst type; Y, yes; H, healed type; F, female; G, generalized peritonitis type; N, no.

^∗ Zangheri's Scoring system of intraabdominal calcifications for MP¹⁰.

^† Means fibroadhesive type.

Table 3.

Postnatal Symptoms and Signs, and Postnatal Imaging Study Modalities and Specific Findings

Postnatal symptoms and signs	N=13
Symptoms and signs	12
Abdominal distension	10
Bilious vomiting	2
Pneumoperitoneum	2
White meconium	1
No meconium passage	1
No symptom	1
Postnatal imaging findings
Plain abdominal radiography	13
Intraabdominal calcification	8
Mass with multiple calcification	2
Intestinal obstruction	3
Contrast enema	10
Microcolon	9
Abdominal ultrasonography	8
Pseudocyst	2
Obstruction/Bowel dilatation	2
Cystic mass	1
Calcification	1
Nonspecific	2
Computed tomography	1
Huge cyst	1

Table 4.

Comparison between Survival and Mortality Groups in Meconium Peritonitis Patients

	Survival (n=11)	Mortality (n=2)	P-value
GA (days)	36.8±1.87	34.5±4.95	0.641
BW (g)	3,159±589	2,355±473	0.103
Age at operation (day)	2.50±1.35	2.0±0.0	0.758
Preoperative pH	7.31±0.91	7.07±0.41	0.769
Preoperative base excess (mEq/L)	-5.70±3.10	-15.70±19.86	0.909
CRP (mg/dL)	0.90±2.32	0.23±2.96	0.758
WBC (/µL)	15,665±6,990	10,930±5,642	0.485
Preoperative hemodynamic	0	2	0.013 (<0.05)
instability
Preoperative ventilator care	0	2	0.013 (<0.05)
Hospital stay (days)	39±25	8.5±7.7	0.154

Preoperative hemodynamic instability and preoperative ventilator care were compared by using Fisher's exact test and other variable were compared by Mann-whitney test for non-parametric test. Abbreviations: GA, gestational age; BW, birth weight; CRP, C-reactive protein; WBC, white blood cell.

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