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Meconium Peritonitis
Steven J. Kraus, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Meconium peritonitis (MP): Chemical peritonitis resulting from in utero bowel perforation that leaks sterile meconium & digestive enzymes into peritoneal cavity
            • Meconium cyst: Meconium + fluid contained by fibrous membranes in setting of MP
            • Meconium pseudocyst: Meconium + fluid contained by membranes partly derived from muscular layer of intestine

          IMAGING

          • General Features

            • Radiographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Fluoroscopic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Sciarrone A et al: Fetal midgut volvulus: report of eight cases. J Matern Fetal Neonatal Med. 29(8):1322-7, 2016
                                          2. Lee GS et al: Calcified meconium pseudocyst: X-ray diagnosis of meconium peritonitis at birth. BMJ Case Rep, 2015
                                          3. Uchida K et al: Meconium peritonitis: prenatal diagnosis of a rare entity and postnatal management. Intractable Rare Dis Res. 4(2):93-7, 2015
                                          4. Veyrac C et al: US assessment of neonatal bowel (necrotizing enterocolitis excluded). Pediatr Radiol. 42 Suppl 1:S107-14, 2012
                                          5. Izumi Y et al: Prenatal treatment of meconium peritonitis with urinary trypsin inhibitor. Ultrasound Obstet Gynecol. 37(3):366-8, 2011
                                          6. Jeanty C et al: Prenatal diagnosis of meconium periorchitis and review of the literature. J Ultrasound Med. 28(12):1729-34, 2009
                                          7. Regev RH et al: Meconium periorchitis: intrauterine diagnosis and neonatal outcome: case reports and review of the literature. J Perinatol. 29(8):585-7, 2009
                                          8. Saleh N et al: Prenatal diagnosis and postnatal management of meconium peritonitis. J Perinat Med. 37(5):535-8, 2009
                                          9. Tsai MH et al: Clinical manifestations in infants with symptomatic meconium peritonitis. Pediatr Neonatol. 50(2):59-64, 2009
                                          10. Featherstone NC et al: Meconium per vagina: a rare presentation of meconium peritonitis. J Pediatr Surg. 43(1):e5-7, 2008
                                          11. Okawa T et al: Repeated paracentesis in a fetus with meconium peritonitis with massive ascites: a case report. Fetal Diagn Ther. 24(2):99-102, 2008
                                          12. Pelizzo G et al: Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int. 24(9):1061-5, 2008
                                          13. Nam SH et al: Experience with meconium peritonitis. J Pediatr Surg. 42(11):1822-5, 2007
                                          14. Zangheri G et al: Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery. Prenat Diagn. 27(10):960-3, 2007
                                          15. Chan KL et al: Meconium peritonitis: prenatal diagnosis, postnatal management and outcome. Prenat Diagn. 25(8):676-82, 2005
                                          16. Eckoldt F et al: Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn. 23(11):904-8, 2003
                                          17. Ekinci S et al: Inguinal hernia as a rare manifestation of meconium peritonitis: report of a case. Surg Today. 32(8):758-60, 2002
                                          18. Park WH et al: Congenital gastric teratoma with gastric perforation mimicking meconium peritonitis. J Pediatr Surg. 37(5):E11, 2002
                                          19. Su WH et al: Fetal meconium peritonitis in the infant of a woman with fulminant hepatitis B. A case report. J Reprod Med. 47(11):952-4, 2002
                                          20. Han SJ et al: Biliary atresia associated with meconium peritonitis caused by perforation of small bowel atresia. J Pediatr Surg. 36(9):1390-3, 2001
                                          21. Hu MX et al: An unusual case of neonatal peritoneal calcifications associated with hydrometrocolpos. Pediatr Radiol. 31(10):742-4, 2001
                                          22. Agarwal N et al: Idiopathic origin of meconium peritonitis. Indian J Pediatr. 67(11):845-6, 2000
                                          23. Kamata S et al: Meconium peritonitis in utero. Pediatr Surg Int. 16(5-6):377-9, 2000
                                          24. Khadaroo RG et al: Fetus-in-fetu presenting as cystic meconium peritonitis: diagnosis, pathology, and surgical management. J Pediatr Surg. 35(5):721-3, 2000
                                          25. Reynolds E et al: Meconium peritonitis. J Perinatol. 20(3):193-5, 2000
                                          26. Shimotake T et al: Ultrasonographic detection of intrauterine intussusception resulting in ileal atresia complicated by meconium peritonitis. Pediatr Surg Int. 16(1-2):43-4, 2000
                                          27. Varkonyi I et al: Meconium periorchitis: case report and literature review. Eur J Pediatr Surg. 10(6):404-7, 2000
                                          28. Berrocal T et al: Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19(5):1219-36, 1999
                                          29. Kolker SE et al: Disseminated intravascular meconium in a newborn with meconium peritonitis. Hum Pathol. 30(5):592-4, 1999
                                          30. McDuffie RS Jr et al: Fetal meconium peritonitis after maternal hepatitis A. Am J Obstet Gynecol. 180(4):1031-2, 1999
                                          31. Niramis R et al: Meconium peritonitis. J Med Assoc Thai. 82(11):1063-70, 1999
                                          32. Ramesh JC et al: Meconium peritonitis: prenatal diagnosis and postnatal management--a case report. Med J Malaysia. 54(4):528-30, 1999
                                          33. Salman AB et al: Abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis. J Pediatr Surg. 34(9):1415-6, 1999
                                          34. Tatekawa Y et al: The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int. 15(8):549-52, 1999
                                          35. Patton WL et al: Systemic spread of meconium peritonitis. Pediatr Radiol. 28(9):714-6, 1998
                                          36. Tseng CW et al: Color Doppler energy in prenatal diagnosis of meconium peritonitis: a case report. Changgeng Yi Xue Za Zhi. 20(1):58-61, 1997
                                          37. Ali SW et al: Meconium peritonitis--a leading cause of neonatal peritonitis in Kashmir. Indian J Pediatr. 63(2):229-32, 1996
                                          38. Dirkes K et al: The natural history of meconium peritonitis diagnosed in utero. J Pediatr Surg. 30(7):979-82, 1995
                                          39. DuBois JJ et al: Inflammatory pseudocyst associated with trisomy 21 and Hirschsprung's disease. Mil Med. 160(9):477-9, 1995
                                          40. Konje JC et al: Antenatal diagnosis and management of meconium peritonitis: a case report and review of the literature. Ultrasound Obstet Gynecol. 6(1):66-9, 1995
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Meconium peritonitis (MP): Chemical peritonitis resulting from in utero bowel perforation that leaks sterile meconium & digestive enzymes into peritoneal cavity
                                                    • Meconium cyst: Meconium + fluid contained by fibrous membranes in setting of MP
                                                    • Meconium pseudocyst: Meconium + fluid contained by membranes partly derived from muscular layer of intestine

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Fluoroscopic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Sciarrone A et al: Fetal midgut volvulus: report of eight cases. J Matern Fetal Neonatal Med. 29(8):1322-7, 2016
                                                                                  2. Lee GS et al: Calcified meconium pseudocyst: X-ray diagnosis of meconium peritonitis at birth. BMJ Case Rep, 2015
                                                                                  3. Uchida K et al: Meconium peritonitis: prenatal diagnosis of a rare entity and postnatal management. Intractable Rare Dis Res. 4(2):93-7, 2015
                                                                                  4. Veyrac C et al: US assessment of neonatal bowel (necrotizing enterocolitis excluded). Pediatr Radiol. 42 Suppl 1:S107-14, 2012
                                                                                  5. Izumi Y et al: Prenatal treatment of meconium peritonitis with urinary trypsin inhibitor. Ultrasound Obstet Gynecol. 37(3):366-8, 2011
                                                                                  6. Jeanty C et al: Prenatal diagnosis of meconium periorchitis and review of the literature. J Ultrasound Med. 28(12):1729-34, 2009
                                                                                  7. Regev RH et al: Meconium periorchitis: intrauterine diagnosis and neonatal outcome: case reports and review of the literature. J Perinatol. 29(8):585-7, 2009
                                                                                  8. Saleh N et al: Prenatal diagnosis and postnatal management of meconium peritonitis. J Perinat Med. 37(5):535-8, 2009
                                                                                  9. Tsai MH et al: Clinical manifestations in infants with symptomatic meconium peritonitis. Pediatr Neonatol. 50(2):59-64, 2009
                                                                                  10. Featherstone NC et al: Meconium per vagina: a rare presentation of meconium peritonitis. J Pediatr Surg. 43(1):e5-7, 2008
                                                                                  11. Okawa T et al: Repeated paracentesis in a fetus with meconium peritonitis with massive ascites: a case report. Fetal Diagn Ther. 24(2):99-102, 2008
                                                                                  12. Pelizzo G et al: Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int. 24(9):1061-5, 2008
                                                                                  13. Nam SH et al: Experience with meconium peritonitis. J Pediatr Surg. 42(11):1822-5, 2007
                                                                                  14. Zangheri G et al: Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery. Prenat Diagn. 27(10):960-3, 2007
                                                                                  15. Chan KL et al: Meconium peritonitis: prenatal diagnosis, postnatal management and outcome. Prenat Diagn. 25(8):676-82, 2005
                                                                                  16. Eckoldt F et al: Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn. 23(11):904-8, 2003
                                                                                  17. Ekinci S et al: Inguinal hernia as a rare manifestation of meconium peritonitis: report of a case. Surg Today. 32(8):758-60, 2002
                                                                                  18. Park WH et al: Congenital gastric teratoma with gastric perforation mimicking meconium peritonitis. J Pediatr Surg. 37(5):E11, 2002
                                                                                  19. Su WH et al: Fetal meconium peritonitis in the infant of a woman with fulminant hepatitis B. A case report. J Reprod Med. 47(11):952-4, 2002
                                                                                  20. Han SJ et al: Biliary atresia associated with meconium peritonitis caused by perforation of small bowel atresia. J Pediatr Surg. 36(9):1390-3, 2001
                                                                                  21. Hu MX et al: An unusual case of neonatal peritoneal calcifications associated with hydrometrocolpos. Pediatr Radiol. 31(10):742-4, 2001
                                                                                  22. Agarwal N et al: Idiopathic origin of meconium peritonitis. Indian J Pediatr. 67(11):845-6, 2000
                                                                                  23. Kamata S et al: Meconium peritonitis in utero. Pediatr Surg Int. 16(5-6):377-9, 2000
                                                                                  24. Khadaroo RG et al: Fetus-in-fetu presenting as cystic meconium peritonitis: diagnosis, pathology, and surgical management. J Pediatr Surg. 35(5):721-3, 2000
                                                                                  25. Reynolds E et al: Meconium peritonitis. J Perinatol. 20(3):193-5, 2000
                                                                                  26. Shimotake T et al: Ultrasonographic detection of intrauterine intussusception resulting in ileal atresia complicated by meconium peritonitis. Pediatr Surg Int. 16(1-2):43-4, 2000
                                                                                  27. Varkonyi I et al: Meconium periorchitis: case report and literature review. Eur J Pediatr Surg. 10(6):404-7, 2000
                                                                                  28. Berrocal T et al: Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19(5):1219-36, 1999
                                                                                  29. Kolker SE et al: Disseminated intravascular meconium in a newborn with meconium peritonitis. Hum Pathol. 30(5):592-4, 1999
                                                                                  30. McDuffie RS Jr et al: Fetal meconium peritonitis after maternal hepatitis A. Am J Obstet Gynecol. 180(4):1031-2, 1999
                                                                                  31. Niramis R et al: Meconium peritonitis. J Med Assoc Thai. 82(11):1063-70, 1999
                                                                                  32. Ramesh JC et al: Meconium peritonitis: prenatal diagnosis and postnatal management--a case report. Med J Malaysia. 54(4):528-30, 1999
                                                                                  33. Salman AB et al: Abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis. J Pediatr Surg. 34(9):1415-6, 1999
                                                                                  34. Tatekawa Y et al: The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int. 15(8):549-52, 1999
                                                                                  35. Patton WL et al: Systemic spread of meconium peritonitis. Pediatr Radiol. 28(9):714-6, 1998
                                                                                  36. Tseng CW et al: Color Doppler energy in prenatal diagnosis of meconium peritonitis: a case report. Changgeng Yi Xue Za Zhi. 20(1):58-61, 1997
                                                                                  37. Ali SW et al: Meconium peritonitis--a leading cause of neonatal peritonitis in Kashmir. Indian J Pediatr. 63(2):229-32, 1996
                                                                                  38. Dirkes K et al: The natural history of meconium peritonitis diagnosed in utero. J Pediatr Surg. 30(7):979-82, 1995
                                                                                  39. DuBois JJ et al: Inflammatory pseudocyst associated with trisomy 21 and Hirschsprung's disease. Mil Med. 160(9):477-9, 1995
                                                                                  40. Konje JC et al: Antenatal diagnosis and management of meconium peritonitis: a case report and review of the literature. Ultrasound Obstet Gynecol. 6(1):66-9, 1995