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11-198
FIGURE 1
Axial section at the level of the fetal abdomen.
Arrow denotes the dense echogenic foci are noted in the
fetal abdomen.
FIGURE 2
Coronal section at the fetal abdomen.
Arrow denotes the dense echogenic foci in the fetal abdomen.
From the Department of Radio diagnosis, Dr Padm D.Y.Patil Medical College. Pimpri - 18.
Request for Reprints: Dr Amit T Kharat, Flat No 2, Building No 34, Ranakpur Darshan Society, New Alandi Road, Vishrantwadi,
Yerawada Pune - 411006
Received 20 November 2005; Accepted 10 February 2006
378
378 AT Kharat et al
DISCUSSION:
Meconium peritonitis is a sterile chemical peritonitis
secondary to passage of meconium into the peritoneum
(1, 2). It is a rare condition with a frequency of 1 in 35,000
in neonates. Since some cases occurring in utero may
resolve or may be clinically inapparent at delivery, the
actual frequency may be higher(3).
This chemical peritonitis results from intrauterine bowel
perforation and almost always involves the small bowel
(4). Prenatal bowel perforation usually occurs proximal
to some form of obstruction, although this cannot always
be demonstrated (5). The extruded bowel contents provoke
an intense peritoneal inflammatory reaction, leading to
the formation of dense fibrotic tissue. This tissue calcifies,
resulting in the characteristic intraperitoneal calcifications
identified prior to birth with ultrasound and after birth with
abdominal radiograph.
Pathologically, meconium peritonitis can be divided into
fibro-adhesive (type I), (pseudo) cystic (type II), generalized
(type III) and microscopic (type IV).6
Antenatal ultrasound findings of bowel dilatation, ascites
and polyhydramnios have been associated with MP (7).
The presence of intraperitoneal calcification, however, is
the most common characteristic and consistent finding.(7,
8).
Meconium peritonitis can be simple or complex (7, 8).
The sole presence of intra-abdominal calcification
indicates simple meconium peritonitis, whereas an
association with ascites, polyhydramnios, and
pseudocyst or bowel dilatation constitutes the complex
variety. In our case only intraabdominal calcifications were
present classifying it as simple meconium peritonitis.
The calcifications appear as linear or clumped foci and
are plaque-like in the abdomen, pelvis and the scrotum
(7). Dilated small bowel is seen in approximately 25% of
cases and indicates mechanical obstruction leading to
perforation (9). Poly -hydramnios and generalized ascites
occur in 60 and 50% of cases, respectively (9).In our
case calcifications were present on the visceral peritoneal
surface of liver and the parietal peritoneum. However no
evidence of dilated bowel/ fetal ascites was detected.
The natural history and outcome of meconium peritonitis
diagnosed antenatally compared with that diagnosed in
neonates are becoming apparent. However, some features
such as dilated bowel loops, ascites and pseudocyst can
also develop later in the course of the disease(10.11).
Hence, serial antenatal scans are required to assess the
progress of peritonitis. Further the timing of diagnosis,
whether in utero or in the neonatal period, is crucial, and
impacts on the prognosis and outcome of the disease.