Maternal meconium granulomatous peritonitis

A 32-year-old woman underwent cesarean section because of fetal distress. Meconium spilled into the incision during delivery. The patient subsequently had a fever, right-sided pleuritic chest pain, a right lower lobe infiltrate, and a pleural effusion. Exploratory laparotomy disclosed intra-abdominal fibrosis with inflammatory mass formation. A biopsy specimen showed a granulomatous reaction around the bile-staining material similar to meconium. The patient was treated with prednisone, and her symptoms abated. During the next four years, episodes of fever, abdominal discomfort, and pleuritis recurred, which eventually responded to indomethacin therapy.