Findings show abundant ascites with debris, a clustering of hyperechogenic
intestines with no peristalsis.
Diagnosis
: Meconium peritonitis
Discussion
Meconium peritonitis is a rare condition occurring in 1/35,000 live births.
Any condition causing bowel obstruction may be responsible for bowel distension
and perforation, leading to a sterile chemical peritonitis. Meconium ileus,
which related to cystic fibrosis in 90% of cases, accounts for less than
25%. More frequently, mechanical bowel obstruction is provoked by intestinal
atresia, volvulus, intussusception or herniation.
Associated
malformations
Cystic fibrosis is associated with meconium ileus and subsequent meconium
peritonitis in about 15% of cases. Polyhydramnios is present in 10-64%
of cases and has been attributed to difficulty in swallowing as the result
of deficient bowel peristalsis. On rare occasions, fetal hydrops may be
present.
Antenatal Diagnosis
Prenatal diagnosis is suspected when fetal intra-abdominal calcifications
are observed, especially in association with fetal ascites and polyhydramnios.
Fetal bowel obstruction associated with fast developing fetal ascites
or hydrops is usually noted. On rare occasions, however, fetal ascites
regresses, intestinal dilatation disappears and peristalsis reappears.
Only hyperechoic area remains. Sometimes, intra-abdominal meconium pseudocysts
are the sole remnants of the meconium peritonitis.
Net Links:
http://www.thefetus.net/sections/articles/Gastrointestinal_splenic_and_abdominal_wall
Dr.
Latha Natrajan, India
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