EP16.13: Prenatal sonographic diagnosis of meconium peritonitis and postnatal management: a report of two cases

Meconium peritonitis is a sterile inflammatory reaction in the fetal abdomen resulting from in-utero bowel perforation that usually involves the small bowel, with an incidence of 1 out of 30,000 live births. The perforation during intrauterine life is secondary to congenital intestinal obstruction, such as with meconium ileus, bowel atresia, stenosis, internal hernia, neonatal Hirschprung's disease, or volvulus. Prenatal diagnosis is suspected when fetal intra-abdominal calcifications are detected, which can be associated with fetal ascites and polyhydramnios. On rare occasion, ascites regresses, intestinal dilatation disappears, and only hyper-echoic area persists or meconium pseudocyst can be the only remnant. The cases described here represent two of the classic presentations of meconium peritonitis. The first case presented with an antenatal diagnosis of a meconium pseudocyst and ileal atresia and despite exploratory lapratomy with end to side duodenojejunostomy, the baby did not survive. The second case presented with intra-abdominal dense calcification as a remnant of healed bowel perforation during the prenatal period and a healthy baby was discharged on postnatal day 6. In conclusion, a vital aspect in the management is to rule out chromosomal malformations, congenital infections, and cystic fibrosis. Thus, prenatal diagnosis by ultrasound and frequent follow up imaging is important in prompting early postnatal surgical intervention thus improving neonatal outcome.