Meconium per vagina: a rare presentation of meconium peritonitis

Area of Science:

• Neonatal surgery
• Pediatric gastroenterology
• Fetal medicine

Background:

• Meconium peritonitis arises from antenatal gastrointestinal perforation, typically presenting as obstruction, masses, or calcification.
• Passage of meconium per vaginam in neonates secondary to meconium peritonitis is an exceptionally rare clinical presentation.

Observation:

• This report details a neonate with passage of meconium per vaginam attributed to ileal atresia and meconium peritonitis.
• Initial assessments suggested rectal atresia with a rectovaginal fistula, which was later disproven.
• Radiologic and surgical findings were crucial in diagnosing the underlying condition.

Findings:

• Ileal atresia was identified as the cause of meconium peritonitis and subsequent vaginal meconium passage.
• The anatomical pathway for meconium passage into the vagina remains uncertain, with possibilities including a cyst decompressing via the fallopian tube or direct peritoneal-vaginal perforation.

Implications:

• This case expands the differential diagnosis for neonatal gastrointestinal emergencies and vaginal abnormalities.
• It underscores the importance of comprehensive radiologic and surgical evaluation in atypical neonatal presentations.
• Understanding rare pathways of meconium passage can inform management strategies for similar complex cases.