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The Journal of Maternal-fetal &... Dec 2024The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis...
BACKGROUND
The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP.
METHODS
The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed.
RESULTS
The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference ( > .05) in the occurrence of various prenatal ultrasound findings by etiology.
CONCLUSION
Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Intestinal Perforation; Meconium; Peritonitis; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 38403928
DOI: 10.1080/14767058.2023.2250045 -
Clinical Case Reports Dec 2023Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum...
Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum with echogenic fluid and debris. In this report, we describe a case in which a prenatal diagnosis of MPO was accurately made at 32 weeks of gestation. The neonate delivered without complications, underwent immediate evaluation followed by major surgery, and ultimately had a favorable outcome. An accurate prenatal diagnosis is important to counsel the patient in a multidisciplinary approach. This case highlights the prenatal ultrasound findings as well as the neonatal presentation and the possibility for conservative management by pediatric urology.
PubMed: 38107083
DOI: 10.1002/ccr3.8319 -
Asian Journal of Surgery Nov 2023article's main point: This article retrospectively analyzes clinical data from a rare case of fetal retroperitoneal solid, mature teratoma, aiming to provide insights...
article's main point: This article retrospectively analyzes clinical data from a rare case of fetal retroperitoneal solid, mature teratoma, aiming to provide insights into diagnosing and treating fetal teratomas. This case of fetal retroperitoneal teratoma provides the following insights into diagnosis and treatment: 1) Due to the special nature of the retroperitoneal space, retroperitoneal tumours grow hidden, especially in fetal retroperitoneal tumours that are even more difficult to detect. Prenatal ultrasound screening is of great value for the diagnosis of this disease. 2) Although ultrasound can determine the location and blood flow of the tumour and monitor changes in its size and composition, there is a certain degree of misdiagnosis due to fetal position, clinical experience, and imaging resolution. When necessary, fetal MRI can provide further evidence for prenatal diagnosis. 3) Although fetal retroperitoneal teratoma is rare, a few tumours grow rapidly and have the potential for malignant transformation. When a solid cystic mass lesion in the retroperitoneal space is found during the fetal period, this disease should be considered as one of the differential diagnoses and distinguished from fetal renal tumours, adrenal tumours, pancreatic cysts, meconium peritonitis, parasitic fetus, and lymphangioma, among others. 4) Based on the situation of the pregnant woman, fetus, and tumour, the time and method of termination of pregnancy should be decided. After birth, the timing and manner of surgery and postoperative follow-up should be determined by neonatology and pediatric surgery.
Topics: Female; Child; Humans; Infant, Newborn; Pregnancy; Retroperitoneal Space; Retroperitoneal Neoplasms; Retrospective Studies; Teratoma; Fetus; Magnetic Resonance Imaging
PubMed: 37202258
DOI: 10.1016/j.asjsur.2023.05.016 -
International Journal of Surgery Case... Jul 2023Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature....
INTRODUCTION AND IMPORTANCE
Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature. Diagnosis requires histological confirmation, and treatment includes urgent laparotomy, resection of affected areas, and end-to-end anastomosis or creation of stomas. The work has been reported in line with the SCARE guideline criteria.
CASE REPORT
We present the case of a 31-week preterm newborn with prenatal diagnosis of polyhydramnios and non-immune fetal ascites. Radiological tests confirmed meconium peritonitis, and laparotomy was indicated. The patient had a torpid postoperative course requiring multiple surgeries due to intestinal occlusion and leakage of the anastomosis. Finally, he was discharged with good oral tolerance and bowel function. The anatomopathological examination reported the congenital absence of intestinal muscle with segmental and multifocal distribution.
CLINICAL DISCUSSION
Most neonatal cases share similar clinical features, and if SAIM is suspected during surgery, the suspicious areas should be resected to prevent future complications. The prognosis depends on the extent of the lesion, possibility of resecting affected segments, and concomitant pathologies.
CONCLUSION
In conclusion, this study aims to describe SAIM based on a clinical case and review of the literature. SAIM is a rare pathology that requires prompt diagnosis and treatment to prevent complications. Surgeons should consider resecting suspicious areas during surgery to prevent future complications.
PubMed: 37390581
DOI: 10.1016/j.ijscr.2023.108424 -
Yonago Acta Medica Nov 2023In recent years, the number of neonatal surgeries has been on the rise despite the decline in the number of births, and we examined the actual trends and problems at...
BACKGROUND
In recent years, the number of neonatal surgeries has been on the rise despite the decline in the number of births, and we examined the actual trends and problems at Tottori University Hospital located in the Sanin region.
METHODS
Medical records were retrospectively searched for patients who underwent major surgery during the neonatal period (within 30 days of age) at the Tottori University Hospital over the past 10 years (Jan. 2011 to Dec. 2020).
RESULTS
Sixty-five cases were included. Early birth infants (< 37 gestational weeks) comprised 15 cases (23%) and low birth weight (< 2500 g) infants involved 27 cases (42%). In the latter half (2016-2020), early birth and low birth weight infants were significantly less than in the first half (2011-2015). The common diseases were anorectal malformation (14 cases), esophageal atresia (10), duodenal atresia (10), and diaphragmatic hernia (9). Prenatal diagnosis was obtained in 26 cases (40%), with high diagnostic rate obtained in duodenal atresia (100%), abdominal wall defect (100%), ileal atresia (75%), meconium peritonitis (67%), and diaphragmatic hernia (67%). Fifty-five cases (85%) were operated on within 7 days of age. Other major malformations were associated in 23 cases (35%). There were 6 deaths (9%), of which 3 cases were low birth weight infants with gastrointestinal perforation, 2 cases with severe chromosomal abnormalities (esophageal atresia, omphalocele), and 1 case with diaphragmatic hernia with severe pulmonary hypertension. Home medical care has been required with gastrostomy tube in 2 cases.
CONCLUSION
Neonatal surgery at Tottori University has been well performed as required with acceptable results along with the progression of other perinatal care. However, further investigation for improvements in premature delivery or organ hypoplasia may be required.
PubMed: 38028267
DOI: 10.33160/yam.2023.11.003 -
SAGE Open Medical Case Reports 2024Multiple intestinal atresia with combined immune deficiency is a severe autosomal recessive disorder caused by the tetratricopeptide repeat domain 7A () gene deficiency,...
Multiple intestinal atresia with combined immune deficiency is a severe autosomal recessive disorder caused by the tetratricopeptide repeat domain 7A () gene deficiency, which is characterized by extensive intestinal defects with immune deficiency. This report describes a fetus with deficiency who developed meconium peritonitis in utero. Evidence suggests that patients with deficiency present with intestinal defects as early as in utero. In this case, intestinal abnormalities were considered during the prenatal examination at week 28, and chromosome and genetic tests were performed. The results indicated that the fetus had a complex heterozygous mutation. The male infant underwent surgical treatment after birth and developed severe infection and sepsis, which confirmed the presence of multiple intestinal atresia with combined immune deficiency. Our case suggests an association between meconium peritonitis and the gene deficiency, indicating the possibility of severe intestinal defects and immune deficiencies after birth and guiding subsequent fetal treatment choices.
PubMed: 38292879
DOI: 10.1177/2050313X241227129