OBGY Radiology

Case 12
Routine OBGY scan. Diagnosis please!
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Findings show abundant ascites with debris, a clustering of hyperechogenic intestines with no peristalsis.

Diagnosis : Meconium peritonitis

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.

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Dr. Latha Natrajan, India