Meconium Peritonitis Connecting the Dots between Pathophysiology, Prenatal Diagnosis and Postnatal Outcome

Abstract

Background: Meconium peritonitis is a unique clinical and radiological entity, occurring in 1 in 30,000 pregnancies, and is defined as sterile chemical peritonitis caused by the release of meconium into the peritoneal cavity in utero, leading to an inflammatory reaction. This condition can be detected by antenatal ultrasound, with some cases reported in severe clinical presentations, and is associated with high morbidity and mortality.

Case Report: 28-year-old woman, primigravida at 34/35 weeks of gestation, referred to the High-Risk Pregnancy Clinic at dr. Soetomo General Academic Hospital, Surabaya, with hyperechoic bowel appearance. Serial ultrasonography revealed echogenic bowel and ascites; no signs of major congenital anomalies in other organs were found. IgG for toxoplasma and cytomegalovirus are reactive with high avidity. Based on the Zangheri classification, the patient was diagnosed with meconium peritonitis grade I. The patient gave birth to a baby girl at 38/39 weeks of gestation, birthweight 2,460 g, birth length 50 cm, and APGAR score of 8-9. Postnatal evaluation by pediatric surgeon indicated no signs of acute peritonitis. Babygram was within normal limits. The baby was diagnosed with meconium peritonitis and early-onset sepsis, and was treated with empirical antibiotics. The baby was treated for 6 days until improvement was observed.

Conclusion: The management of rare diseases is faced with diagnostic and therapeutic dilemmas. Intra-abdominal calcification, ascites, pseudocyst, and intestinal dilation characterize meconium peritonitis. The Zangheri classification divides the severity of this disease and predicts that postnatal operative interventions increase in severe cases. Asymptomatic and mild clinical presentations can occur because intestinal perforation closes spontaneously in utero, so in these cases, delivery can be performed at term pregnancy and no surgical intervention is required.