Treatment of meconium peritonitis in the antenatal and postnatal periods during pregnancy and after childbirth (a clinical case)

Abstract

Introduction. This article describes a clinical case of a pregnant woman with fetal meconium peritonitis and further observation and treatment of the child. Meconium peritonitis, being aseptic intrauterine peritonitis, is a serious disease that requires an integrated approach. Tactics of management the fetus, intrauterine risks and prognosis of survival in this pathology as well as choice of the technique for correcting meconium peritonitis and its complications during pregnancy and after childbirth are discussed.
Material and methods. Prenatal ultrasound examination revealed in a male fetus signs of low intestinal obstruction, distortion of bowel loops, calcifications, ascites and polyhydramnios. This case shows that depending on the clinical course of peritonitis the timely performed diagnostics reduces risks of life-threatening complications.
Results. Due to the newly developed ultrasound criteria which assess the pathology severity (meconium ascites, compression of the fetal chest cavity, edema and polyhydramnios), it became possible to predict the course of meconium peritonitis. Management of pregnancy, childbirth and neonatal period as well as therapeutic and surgical correction of this severe pathology with further early rehabilitation are described in details.
Conclusion. Meconium peritonitis is a pathology in which a timely established prenatal diagnosis is extremely important because it significantly improves prognosis and allows to take adequate steps prenatally for stabilizing the condition of both a fetus and a pregnant woman.

Keywords

Meconium peritonitis / pregnancy / amniolaparocentesis

References

[1] Игнатьев Е. М., Караваева С. А., Котин А. Н., и др. Об опыте хирургического лечения мекониевого перитонита. Научные ведомости БелГУ. Серия: Медицина. Фармация. 2012; 123(4).

[2] Cerise E.J., Whitehead W. Meconium peritonitis. Am Surg. 1969; 35: 389.

[3] Wang C.N., Chang S.D., Chao A.S., et al. Meconium peritonitis in determining neonatal outcome. Taiwan J Obstet Gynecol. 2008; 47(4): 391–6.

[4] Nam S.H., Kim S.C., Kim D., et al. Experience with meconium peritonitis. Journal of pediatric surgery. 2007; 42(11): 1822-5 .

[5] Lorimer W.S.Jr, Ellis D.G. Meconium peritonitis. Surgery. 1966 Aug; 60(2): 470-5. PMID: 5920370.

[6] Ein S.H., Shandling B., Reilly B.J., Stephens C.A. Bowel perforation with nonoperative treatment of meconium ileus. J Pediatr Surg. 1987; 22(2): 146-7. doi: 10.1016/s0022-3468(87)80434-7.

[7] Немилова Т.К., Караваева С.А., Игнатьев Е.М. Мекониевый перитонит: современная трактовка, диагностика, тактика, лечение. Вестник хирургии имени И.И.Грекова . 2012; 171(4): 108-11.

[8] Wang Y., Wu Y., Guan W., et al. Meconium peritonitis due to fetal appendiceal perforation: two case reports and a brief review of the literature. BMC Pediatr. 2018 May 11; 18(1): 162. doi: 10.1186/s12887-018-1133

[9] Караваева С.А., Игнатьев Е.М., Котин А.Н., и др. Мекониевый перитонит у детей с дуоденальной атрезией. Неонатология, хирургия и перинатальная медицина. 2012; 2(2): 120-3.

[10] McDuffie R.S.Jr., Bader T. Fetal meconium peritonitis after maternal hepatitis A. Am J Obstet Gynecol. 1999 Apr; 180(4): 1031-2. doi: 10.1016/s0002-9378(99)70678-2

[11] Shinmoto H., Kuribayashi, S. MRI of fetal abdominal abnormalities. Abdom Imaging. 2003; 28: 877–86. https://doi.org/10.1007/s00261-0030047-5

[12] Gupta P., Sharma R., Kumar S., Gadodia A., Roy K.K., Malhotra N., Sharma J.B. Role of MRI in fetal abdominal cystic masses detected on prenatal sonography. Arch Gynecol Obstet. 2010 Mar; 281(3): 519-26. doi: 10.1007/s00404-009-1190-1

[13] Zangheri G., Andreani M., Ciriello E., Urban G., Incerti M., Vergani P. Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery. Prenat Diagn. 2007 Oct; 27(10): 960-3. doi: 10.1002/pd.1812

[14] Pelizzo G., Codrich D., Zennaro F., Dell’oste C., Maso G., D’Ottavio G., Schleef J. Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int. 2008 Sep; 24(9): 1061-5. doi: 10.1007/s00383-008-2194-9

[15] Nam S.H., Kim S.C., Kim D.Y., et al. Experience with meconium peritonitis. J. Pediatric Surgery. 2007 Nov; 42(11): 1822-5. DOI: https://doi.org/10.1016/j.jpedsurg.2007.07.006

[16] Hibi M., Shimotake T., Iwai N. Combined esophageal and duodenal atresia complicated with meconium peritonitis. Pediatr. Surg. Int. 2003 Oct; 19(7): 564-5. DOI: 10.1007/s00383-002-0946-5