Meconium Peritonitis
RANGSAN NIRAMIS, M.D.*,
MAITREE ANUNTAKOSOL, M.D.*,
VEERA BURANAKITJAROEN, M.D.*
SUKAWAT WATANATITTAN, M.D., F.A.C.S.*,
TONGKAO RATTANASUWAN, M.D.*,
Affiliation : * Department of Surgery, Children's Hospital, Rajavithi Road, Bangkok 10400, Thailand.
AbstractMeconium peritonitis IS an unusual and often fatal form of neonatal peritonitis charac-
terized by intraperitoneal calcification, numerous fibrosis with or without pseudocyst formation
due to antenatal extravasation of meconium. This report is a retrospective study of 32 pediatric
patients who were treated at the Surgical Department of the Children's Hospital from 1987 to
1996. The purposes of this study emphasize clinical manifestations, radiological findings,
operative procedures and results of treatment. Twenty seven were neonates and five were
older infants. The most common clinical presentation was abdominal distension at birth. The
abdominal X-rays showed abnormal calcification and mass lesion in the peritoneal cavity in 71.9
and 46.9 per cent respectively. Only one patient was not treated surgically because he had no
evidence of gut obstruction and inflammation. Thirty-one patients were operated on. At laparo-
tomy, all of them had numerous inflammatory adhesion bands and matted bowel loops. Giant
pseudocysts and intestinal perforations were noted in 64.5 and 54.8 per cent respectively. The
obvious causes of meconium peritonitis were ileal atresia in 4, jejunal atresia in 3 and appendiceal
perforation in 1. In the other 23 patients, no apparent cause of perforation was noted.
Only lysis of the adhesion with or without drainage was done in 9 patients and one of
these died. Partial resection of pseudocysts and exterioization of the perforated bowel were
done in 10 patients and 2 of these babies died. Primary anastomosis after resection of the per-
forated bowel was done in 12 patients and 5 of these cases died. The overall survival rate was 75
per cent.
Our data from this study suggested that partial resection of the pseudocyst and tem-
porary enterostomy should be done in cases with bowel perforation and severe meconium con-
tamination. Early diagnosis, proper operative procedure and meticulous postoperative care offer
the best opportunity for survival of patients with meconium peritonitis.
Keywords : Meconium Peritonitis
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