Meconium peritonitis--a leading cause of neonatal peritonitis in Kashmir

Meconium peritonitis is a chemical reaction of peritonium to meconium which occurs due to leakage of meconium into peritoneal cavity as a result of perforation of intestines antinatally which gets subsequently sealed. In the present retrospective study, 39 cases of neonatal peritonitis were studied. Meconium peritonitis was diagnosed if a) abdominal X-ray showed diffuse calcifications (b) abdominal paracentesis showed meconium aspirate and c) leprotomy examination. Twenty (51.3%) out of 39 cases of neonatal peritonitis were found to have meconium peritonitis. These included 14 boys and 6 girls, birth weight ranged from 1500 gms to 3200 gms and mean age of presentation included abdominal distension in 100% cases, H/O not passing meconium in 50% cases, Ascites in 45% cases and vomiting in 40% cases, 30% presented with abdominal mass. Pseudocyst formation on X-ray was seen in 23% cases which was much higher than reported in world literature. Overall mortality in meconium peritonitis was 80%. The incidence of meconium peritonitis in this part of country in much higher than reported in Western and Indian literature. The high incidence may be due to underlying cystic fibrosis because Kashmir has a more homogenous population and consanguinity is very common. A prospective study including sweat chloride testing needs to be undertaken to look into the cause for proportionately higher occurrence of meconium peritonitis in Kashmir with particular reference to cystic fibrosis.