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Virtual Pediatric Hospital: Paediapaedia: Meconium Peritonitis Paediapaedia: Gastrointestinal Diseases

Meconium Peritonitis

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Abdominal distension.

Etiology/Pathophysiology:
Meconium peritonitis may complicate any intrauterine bowel perforation. Causes include intestinal atresia or complicated meconium ileus. Meconium is a sterile mixture and consists of desquamated epithelial cells, vernix, lanugo hair, and intestinal secretions containing cholesterol and mucopolysaccharides. When meconium spills into the peritoneum it acts as an irritant and an inflammatory serosal reaction develops leading to formation of foci that can calcify within 24 hours.

Pathology:
There are 3 types of meconium peritonitis:
1. Fibroadhesive - an intense adhesive peritoneal reaction with no active leak of bowel contents.
2. Cystic - a localized cavity formed by adjacent loops of bowel.
3. Generalized - no adhesions or calcifications, seen in cases where the bowel perforation occurs just before birth.

Imaging Findings:
Can see a few irregular scattered areas of calcification, or can see extensive, continuous linear areas of calcification. In cystic meconium peritonitis the calcifications may outline a soft tissue mass. In generalized meconium peritonitis, ascites is often seen, along with other signs of bowel obstruction and perforation. The calcifications disappear in 2-3 months.

DDX:

References:
See References Chapter.

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