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Prenatal Sonologic Features Of Simple Meconium Peritonitis

AT KHARAT, R PRATHIMA, A SINGH, D JACOB
Abstract
A 25 yrs old female patient came to our department for routine antenatal ultrasound. Sonography revealed
presence of a 24 week live intrauterine pregnancy. During routine screening for congenital anomalies,
multiple highly echogenic foci were seen on the visceral peritoneal surface of liver and the parietal
peritoneum. However no evidence of dilated bowel/ fetal ascites was detected. No other anomaly was
detected.
Ind J Radiol Imag 2006 16:3:377-378
Key words : - Meconium peritonitis, ultrasound.
CASE HISTORY:
A 25 yr old female patient came to our department for
routine antenatal ultrasound. There was no significant
past relevant history of TORCH infections. Previous
ultrasound scans were unremarkable.
IMAGING FINDINGS:
Study was carried using WIPRO- GE Logiq 400 MD TM
scanner with 3.5- 5 MHz convex array transducer.

FIGURE 1
Axial section at the level of the fetal abdomen.
Arrow denotes the dense echogenic foci are noted in the
fetal abdomen.

Sonography revealed presence of a 24 week live

intrauterine pregnancy.
Multiple highly echogenic foci were seen scattered through
out the visceral peritoneal surface of liver and the parietal
peritoneum. (Figure 1 and Figure 2). Few of the clumped
foci demonstrated dense acoustic shadowing. The liver
and spleen were devoid of these calcified foci. The gall
bladder, both kidneys and urinary bladder was normal.
No evidence of fetal ascites or pleural effusion. Fetal lungs
and heart were unremarkable. No evidence of dilated bowel
loops or other anomaly. Based on these findings a
diagnosis of simple meconium peritonitis was made.

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.

IJRI, 16:3, August 2006

In general the simple variety has a better prognosis than
the complex variety. Overall, about 50% of neonates
diagnosed antenatally with complex form and about 20%
of neonates with simple form require surgical
intervention(10).
Due to the guarded prognosis in the complex variety, serial
antenatal scans are necessary to assess the progress
of meconium peritonitis as well as fetal growth and wellbeing. In the absence of an obstetric indication, these
babies can be delivered vaginally at term. Parents are
advised to deliver at a tertiary centre where neonatal
intensive care and paediatric surgical facilities are available.
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