Small bowel (small intestine) - Meconium peritonitis

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Small bowel (small intestine)

Congenital anomalies

Meconium peritonitis

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 13 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Rare prenatal complication in 1 per 30K live births
● GI perforation releases meconium into abdominal cavity, inducing sterile inflammatory reaction and calcium deposition
● Perforation may be due to anoxia leading to bowel ischemia, atresia, congenital bands, Hirschprung’s disease, internal hernia, meconium ileus, stenosis, volvulus or idiopathic
● Presents with fetal distress, maternal polyhydramnios, abdominal distention or a mass
● Newborns with perforation should be evaluated for cystic fibrosis (Pediatr Surg Int 2003;19:75)

Radiology
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● Prenatal ultrasound shows dilated bowel, ascites, polyhydramnios, intra-abdominal calcifications (Prenat Diagn 2005;25:676)
● Ultrasound findings have prognostic value (Fetal Diagn Ther 2003;18:255, Prenat Diagn 2007;27:960)

Case reports
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● 35 week old female with intrauterine distress (Case of the Week #106)

Treatment
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● Surgical
● Gestational age at diagnosis does not predict postnatal outcome (J Pediatr Surg 1995;30:979)

Gross description
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● Organized peritonitis with fibrosis, calcifications, dense intestinal adhesions
● Meconium pseudocyst (fibrous wall) may form

Gross images
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Abdominal cavity

Small intestine

Micro description
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● Peritoneal surface shows fibrinous exudate with microcalcifications, bile pigment-like debris, histiocytes, chronic inflammatory cells

Micro images
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Peritoneal surface

Differential diagnosis
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● Vernix caseosa peritonitis: cheesy white exudate coats the visceral organs after cesarean section (J Obstet Gynaecol 2007;27:660)

End of Small bowel (small intestine) > Congenital anomalies > Meconium peritonitis

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