CHSU Discovery

Abstract

Meconium peritonitis is a sterile chemical reaction due to in-utero bowel obstruction
and perforation with leakage of meconium into the peritonium.(1) Inflammatory
response secondary to the chemical peritonitis could result in ascites, dystrophic
calcifications, and in some cases, cyst formation.(2) There are many underlying causes
for bowel perforation in utero, such as midgut volvulus, internal hernia, atresia of the
small bowel, Hirschprung’s disease, and meconium ileus.(1) However, current literature
shows approximately half of cases are due to idiopathic bowel perforation.(3)
Meconium peritonitis is considered a rare disease with an incident rate of 1 in 30,000
live births.(1) It is classified into three categories: generalized, fibro-adhesive, and
cystic.(4) In the generalized form, calcium plaques are loosely attached and are
dispersed throughout the peritoneal cavity.(5) The fibro-adhesive type is characterized
by thick bands and membranes that develop across and around bowel loops.(5) While
in cystic form, the perforation is maintained by the inflammatory tissue and nearby
segments of the intestine that have adhered together. (5) Following birth, this cyst may
be filled with fluid if perforation has closed off, or it may contain air and bowel content
if it remains connected to the bowel lumen. (5) After birth, this condition can present in
many ways, from being asymptomatic with closed-off peritonitis to extreme peritonitis
requiring immediate surgery.(4) The most common presentations after birth include
respiratory distress, bilious vomiting, abdominal distention, and delayed meconium
passage.(4)