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The Turkish Journal of Pediatrics 2023Meconium peritonitis occurs when meconium leaks into the peritoneal cavity as a result of intrauterine gastrointestinal perforation. In this study, we aimed to evaluate...
BACKGROUND
Meconium peritonitis occurs when meconium leaks into the peritoneal cavity as a result of intrauterine gastrointestinal perforation. In this study, we aimed to evaluate the results of newborn patients who were followed and treated due to intrauterine gastrointestinal perforation in the pediatric surgery clinic.
METHODS
All newborn patients who were followed up and treated for intrauterine gastrointestinal perforation in our clinic between December 2009-2021 were analyzed retrospectively. Newborns who had no congenital gastrointestinal perforation were not included in our study. The data were analyzed using NCSS (Number Cruncher Statistical System) 2020 Statistical Software.
RESULTS
Within twelve years, intrauterine gastrointestinal perforation was detected in 41 newborns, including 26 (63.4%) males, and 15 (36.6%) patients who were operated on in our pediatric surgery clinic. Surgical findings of 41 patients diagnosed with intrauterine gastrointestinal perforation revealed the presence of volvulus (n=21), meconium pseudocyst (n=18), jejunoileal atresia (n=17), malrotation-malfixation anomaly (n=6), volvulus due to internal hernia (n=6), Meckel`s diverticulum (n=2), gastroschisis (n=2), perforated appendicitis (n=1), anal atresia (n=1), and gastric perforation (n=1). Eleven patients (26.8%) died. Total intubation time was significantly higher in deceased cases. Postoperatively, deceased cases passed their first stool significantly earlier than surviving newborns. Besides, ileal perforation was seen significantly more frequently in deceased cases. However, the frequency of jejunoileal atresia was significantly lower in the deceased patients.
CONCLUSIONS
Although sepsis has been held primarily responsible for the deaths in these infants from past to present, insufficiency in lung capacity necessitating intubation negatively affects their survival. Early passage of stool is not always an indicator of good prognosis after the operation, and patients may die due to malnutrition and dehydration, even after they are discharged after feeding, defecating and having weight gain.
Topics: Infant; Male; Child; Infant, Newborn; Humans; Female; Intestinal Volvulus; Retrospective Studies; Meconium; Meckel Diverticulum; Feces
PubMed: 37395958
DOI: 10.24953/turkjped.2022.748 -
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 -
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 -
Khirurgiia 2023We report a patient with combination of esophageal atresia, proximal tracheoesophageal fistula and meconium peritonitis. These two rare disorders have different...
We report a patient with combination of esophageal atresia, proximal tracheoesophageal fistula and meconium peritonitis. These two rare disorders have different etiology, pathogenetic mechanisms and require different diagnostic manipulations and surgical treatments. The authors discuss the features of diagnosis and surgical treatment of this disease.
Topics: Infant, Newborn; Humans; Tracheoesophageal Fistula; Esophageal Atresia; Meconium; Peritonitis; Rare Diseases
PubMed: 37186657
DOI: 10.17116/hirurgia2023051101 -
Cureus Jan 2023A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality...
A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality rate significantly. We presented a case of a neonate with abdominal distension and non-passage of meconium who experienced respiratory distress and was taken for exploratory laparotomy at a tertiary care center due to suspected bowel perforation. The neonate was diagnosed with a meconium pseudocyst intraoperatively as maternal ultrasound and ultrasound of the abdomen of the neonate after birth failed to make a definitive diagnosis; even an X-ray abdomen did not reveal pathognomonic egg-shell calcification. An interesting aspect of this case is the mother's complex obstetric history, which compelled us to conjecture whether it was possible to predict the chances of meconium peritonitis and take steps to prevent it. It must be noted that, despite rigorous research, the researchers could not find reliable literature co-relating the obstetric history of the mother with the formation of a meconium pseudocyst in the neonate.
PubMed: 36788879
DOI: 10.7759/cureus.33625 -
Heliyon Jan 2023Giant cystic meconium peritonitis (MP) is a relatively rare entity. Prompt surgical treatment is required to manage the underlying etiology and reestablish the...
BACKGROUND
Giant cystic meconium peritonitis (MP) is a relatively rare entity. Prompt surgical treatment is required to manage the underlying etiology and reestablish the continuity of the intestines. Despite perinatal and postoperative care improvements, the overall mortality rate is still relatively high. We reported a giant cystic MP that was recognized using antenatal sonography (US). It was successfully treated with primary anastomosis.
CASE PRESENTATION
We presented a female newborn with a chief complaint of abdominal mass. The prenatal sonography showed an intraabdominal cyst at the 28th week of gestation. She was born at the gestational age of 38 weeks via vaginal delivery from a primigravid mother without complications, with a birth weight of 3275 g. Elective surgery was performed at the age of eight days, and a calcified 10 cm cyst was revealed along with severe adhesions. The cyst was found to communicate with the ileum located 30 cm proximal from the ileocecal junction. No malrotation and volvulus were found. The cyst and a portion of the ileum were resected, followed by a primary end-to-end anastomosis. Pathologic examination showed necrotic tissue lined with epithelial tissue with microcalcifications containing bilirubin pigments, consistent with cystic MP. The patient has uneventfully discharged on postoperative day 17. The patient has normal growth and development, except for delayed walking, at the last follow-up of two years of age.
CONCLUSION
Giant cystic MP is a rare disorder that can be detected early using the antenatal US. Our case highlights the importance of early diagnosis for giant cystic MP using the antenatal US leads to prompt surgical treatment and a more favorable prognosis.
PubMed: 36711283
DOI: 10.1016/j.heliyon.2023.e12960 -
Neonatal Network : NN Jan 2023We present a case of an infant born to a mother with COVID-19, who at 24 hours of life was treated with a glycerin suppository for failure to pass meconium and went on...
We present a case of an infant born to a mother with COVID-19, who at 24 hours of life was treated with a glycerin suppository for failure to pass meconium and went on to develop bilious emesis and abdominal distention as feeding continued over the next several hours. After a barium enema identified the distal obstruction, the pediatric surgical team used rectal irrigation to remove a large meconium plug, which mimicked the appearance of the descending colon on plain film, in a case of small left colon syndrome. Although intestinal obstruction in the newborn is rare, it is imperative that it is promptly diagnosed and treated appropriately to avoid negative outcomes; which, even in perhaps the mildest form of functional distal obstruction, meconium plug syndrome, can lead to an impressive clinical illness with risk of intestinal perforation and subsequent meconium peritonitis if the obstruction is not relieved.
Topics: Infant; Female; Infant, Newborn; Humans; Child; Meconium; COVID-19; Intestinal Obstruction; Infant, Newborn, Diseases; Cystic Fibrosis; Fetal Diseases; Vomiting
PubMed: 36631261
DOI: 10.1891/NN-2022-0012 -
Radiographics : a Review Publication of... Feb 2023US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside...
US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside technique for assessment of acute abdominal conditions in neonates. Bedside US can help, complement, and sometimes replace radiographic or contrast-enhanced studies in critically ill and labile neonates who are difficult to transport to the fluoroscopy suite. Some of the features of bedside US can be applied as point-of-care US (POCUS) of the sick neonate. Some of the abdominal conditions in neonates that can be assessed and monitored with bedside US are necrotizing enterocolitis and its complications, malrotation with a midgut volvulus, segmental volvulus, meconium peritonitis, and complicated inguinal hernia. High-resolution US with the use of 15-MHz and higher-frequency probes allows characterization of the bowel anatomy and features of intestinal abnormalities in neonates in fine detail. Color Doppler US and microvascular imaging improve accuracy in the detection and characterization of bowel vascularity, which is important in the treatment and follow-up of patients with intestinal conditions. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Topics: Infant, Newborn; Humans; Intestinal Volvulus; Intestines; Intestinal Diseases; Abdomen; Diagnostic Imaging
PubMed: 36602924
DOI: 10.1148/rg.220110 -
Asian Journal of Surgery Jun 2023
Topics: Male; Infant, Newborn; Humans; Testicular Hydrocele; Meconium; Scrotum; Peritonitis
PubMed: 36593144
DOI: 10.1016/j.asjsur.2022.12.100 -
Frontiers in Pediatrics 2022Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to...
OBJECTIVE
Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to comprehensively analyze the multiple factors on complete enteral nutrition after primary anastomosis, and establish the convenient prediction model.
METHODS
We retrospectively collected reliable information in neonates with intestinal atresia form January 2010 to June 2022. The cox regression analysis was performed to select independent risk factors and develop nomogram. Subsequently, ROC curve, calibration curve and decision curve were drawn to thoroughly evaluate the accuracy and applicability of the model.
RESULTS
The predictors finally included in the model were gestational age, meconium peritonitis, distance from the anastomosis to the ileocecal region, diameter ratio of proximal to distal bowels, and time of initial feeding. The nomogram of predicting the probability of week 2, week 3 and week 4 was drawn and their area under the curve were 0.765, 0.785 and 0.747, respectively. Similarly, calibration and decision curve indicated that the prediction model had a great prediction performance.
CONCLUSION
The clinical value of predictive models can be recognized. The hope is that the predictive model can help pediatricians reduce hospital costs and parental anxiety.
PubMed: 36578664
DOI: 10.3389/fped.2022.1071056