Meconium peritonitis: A 22-year review in a tertiary referral centre
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In brief
In brief
Twenty-two-year retrospective study of 35 neonates with meconium peritonitis demonstrates 84% prenatal detection rate, with polyhydramnios as the most common ultrasound finding. Laparotomy was required in 86% of cases, with small bowel atresia being the predominant pathology and only two mortalities, reflecting improved outcomes through multidisciplinary care.
Written by the GCMD Library team from the article.
Background
Meconium peritonitis (MP) is a sterile, chemical peritonitis resulting from in-utero fetal bowel perforation. Severe cases may lead to serious morbidities and mortalities.
Objective
To review the common antenatal ultrasound abnormalities associated with MP, and identify radiological and clinical prognostic factors.
Materials and Methods
Retrospective review of all neonates with MP from January 1997 to December 2019 treated in our hospital was performed. Antenatal ultrasound findings, clinical presentations and outcomes were analyzed.
Results
Thirty-five neonates (17 males, 18 females) were included in the study. Thirty-two (91.4%) attended antenatal screening, and 27 (84.4%) of them had abnormalities identified on antenatal ultrasound. The most common abnormality was polyhydramnios (43.8%). Nineteen (54.3%) patients were inborn. Twenty (57.1%) patients were born prematurely. Laparotomy was required in 85.7% of patients. The median time to laparotomy was shorter in the inborn group [1 day (0-9 days) vs 4 days (2-34 days), p=0.001], but the duration of post-operative hospital stay was comparable [71 days (16-423 days) vs 73.5 days (23-231 days)]. However, such duration was found to be significantly longer in the pre-term group when compared to full-term [58.5 days (16-89 days) vs 85 (21-423 days), p=0.01]. The most common pathology was small bowel atresia and there were two mortalities.
Conclusion
Due to the advancement in prenatal detection, pediatric anesthesia, intensive care and surgical techniques, the morbidity and mortality of MP has much decreased. Effective multi-disciplinary antenatal counselling facilitated the perinatal management of MP and resulted in comparable prognosis and outcome in inborn and outborn neonates.