Fetal intra-abdominal calcifications from meconium peritonitis: Sonographic predictors of postnatal surgery
San Gerardo Hospital, Italy. Prenatal Diagnosis
(Impact Factor: 3.27).
10/2007; 27(10):960-3. DOI: 10.1002/pd.1812
To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis.
We reviewed our cohort of cases of meconium peritonitis (MP) (n = 13/37, 225 pregnancies or 0.3/1000) as well as those published in the English literature with prenatal ultrasonographic findings and postnatal follow-up (n = 56). The total number of cases (n = 69) was divided into 4 grades of progressive severity based on the number of pertinent sonographic findings: grade 0, isolated intra-abdominal calcifications (n = 18); grade 1, intra-abdominal calcifications and ascites (n = 17) or pseudocyst (n = 2) or bowel dilatation (n = 6); grade 2, two associated findings (n = 20); and grade 3, all sonographic features (n = 6). Presence of polyhydramnios was also recorded. Prenatal predictors of need for neonatal surgery and risk of neonatal death were identified using Chi-square and Fisher exact test, with P < 0.05 considered significant.
Neonatal surgical intervention was required in 0% (0/18) of newborns with grade 0 MP; in 52% (13/25) of those with grade 1; in 80% (16/20) with grade 2; and in 100% (6/6) with grade 3 MP (P < 0.001, Chi-square for trend). Moreover, neonatal surgery was more frequent in the presence than absence of polyhydramnios [69% (18/26) vs 37% (16/43); P = 0.007]. Neonatal mortality was 6% (4/69; 3 after surgery and 1 for premature delivery) and it was confined to the subgroup with polyhydramnios (4/26, 15%).
Prenatal sonographic features are related to postnatal outcome. Persistently isolated intra-abdominal calcifications have an excellent outcome. Delivery in a tertiary care center is recommended when calcifications are associated with other sonographic findings.
Available from: S. Cabré
- "Grade 0, isolated intra-abdominal calcifications; grade 1, intra-abdominal calcifications and ascites or pseudocyst or bowel dilatation; grade 2, two associated findings; grade 3, all sonographic features. The authors found an increasing need for neonatal surgery with higher grades of the sonographic classification . Another study also found a correlation between ultrasound features and clinical implications . "
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ABSTRACT: A case of giant meconium pseudocyst secondary to ileum volvulus perforation is presented. Conventional radiographic features of meconium peritonitis with secondary meconium pseudocyst formation are well described. Our case is unusual in comparison to other cases reported in the literature and needs to be reported because the meconium pseudocyst presented without the typical ultrasound features (calcifications, polyhydramnios and ascites) and was initially identified as an abdominal mass.
We describe the case of a 29-year-old Caucasian woman in her third trimester of pregnancy, in which an abdominal mass was detected in the fetus. The newborn was diagnosed in the early neonatal period with meconium pseudocyst secondary to ileum volvulus perforation.
The prenatal appearance of a meconium pseudocyst can be complemented by other signs of bowel obstruction (if present) such as polyhydramnios and fetal bowel dilatation. This is an original case report of interest to all clinicians in the perinatology and fetal ultrasound field. We consider that the utility of this case is the recognition that a meconium pseudocyst might appear without the typical ultrasound features and should be considered as a differential diagnosis when an echogenic intra-abdominal cyst is seen.
Available from: Yoshiyuki Nakajima
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ABSTRACT: A fetal intraabdominal cystic mass, measuring 6cm, was detected at 30weeks of gestation in a 27-year-old gravida 2 para
1 woman. At 33weeks of gestation, the cyst disappeared. Ultrasonography showed fetal bowel dilatation, polyhydramnios, and
intraabdominal calcifications. Fetal meconium peritonitis was diagnosed prenatally. Because the fetal ileus became worse,
a cesarean section was performed at 35weeks of gestation; a female infant weighing 2,131g with an Apgar score of 8 was delivered.
Six hours after birth, the neonate received an ileostomy. The bowel was reanastomosed 42days after the initial operation.
On postoperative pathology, a meconium pseudocyst was diagnosed. To our knowledge, this is the first report of a large fetal
meconium pseudocyst that developed into the generalized type in the uterus during the preterm antepartum period.
KeywordsMeconium pseudocyst-Meconium peritonitis-Intrauterine ultrasonography-Fetal ultrasonography
Available from: PubMed Central
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ABSTRACT: The recognition of neonatal intestinal perforation relies on identification of free gas in the peritoneum on plain abdominal radiographs and the associated clinical signs. The neonatal bowel takes several hours to fill with gas, potentially obscuring one of the radiological signs of bowel perforation in the neonate.
We describe the case of a male, Caucasian neonate, born prematurely at 35+2 weeks of gestation, who was suspected before birth to be at risk of intestinal perforation, based on antenatal ultrasound signs of bowel obstruction. However, the diagnosis of intestinal perforation after birth was initially delayed because the first abdominal radiograph, requested by the neonatal team, was taken too early in the clinical progression of the neonate's condition. As a consequence, this delayed referral to the paediatric surgical team and definitive management.
This case illustrates how consideration of the timing of abdominal radiographs in suspected intestinal perforation in the neonate may avoid misinterpretation of radiographic signs, thereby avoiding delays in referral and treatment in the crucial first few hours of life.
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