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Published on: June 24, 2020
Meconium Peritonitis: A Rare Treatable Cause of Non-Immune Hydrops
Usha Devi Rajendran1, Jeyanthi Govindarajan1, Umamaheswari Balakrishnan1
1Department of Neonatology, Sri Ramachandra Institute of Medical Sciences, Porur, Chennai, India.
Abstract:
Meconium peritonitis as a cause of non-immune hydrops in neonates is rarely reported. Here we report such a rare occurrence. In our case, a routine antenatal scan at 25 weeks revealed isolated ascites. By 31 weeks of gestation, all features of hydrops were observed in scans. However, antenatal workup for immune and non-immune hydrops was negative. Subsequently, a preterm hydropic female baby was delivered at 32 weeks. She required intubation and ventilator support. An X-ray revealed calcification in the abdomen suggestive of meconium peritonitis. Ultrasound showed gross ascites, a giant cyst compressing the inferior vena cava, and minimal bilateral pleural effusion. Emergency laparotomy revealed meconium pellets and perforation of the ileum. Double-barrel ileostomy was performed, and the edema resolved and activity improved. The baby was discharged after 3 weeks. Ileostomy closure was done at follow-up. The baby is growing well.
Insights
Meconium peritonitis is a rare cause of non-immune hydrops fetalis in newborns. This case highlights the importance of considering this diagnosis in neonates with unexplained hydrops and abdominal calcifications.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Fetal Medicine
Background:
- Non-immune hydrops fetalis (NIHF) is a serious condition in neonates with various underlying causes.
- Meconium peritonitis, inflammation of the peritoneum due to fetal intestinal perforation, is an uncommon cause of NIHF.
Observation:
- A preterm infant presented with hydrops fetalis, ascites, and abdominal calcifications on X-ray.
- Antenatal scans revealed isolated ascites progressing to hydrops, with negative workup for common causes.
- Intraoperative findings included ileal perforation and meconium pellets, confirming meconium peritonitis.
Findings:
- Surgical intervention with double-barrel ileostomy successfully managed the meconium peritonitis and relieved abdominal compression.
- Post-operative recovery was favorable, with resolution of edema and improved clinical status.
- The infant was discharged after 3 weeks and is growing well following ileostomy closure.
Implications:
- This case underscores the significance of recognizing meconium peritonitis as a potential etiology of NIHF in neonates.
- Early diagnosis and prompt surgical management are crucial for improving outcomes in affected infants.
- Further research into the specific mechanisms linking meconium peritonitis to hydrops may refine diagnostic and therapeutic approaches.
