-
Case Reports in Obstetrics and... 2018Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting...
BACKGROUND
Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis.
CASE DESCRIPTION
We present a case of fetal ileal volvulus suspected on third trimester ultrasound, complicated by premature labour, small bowel necrosis, and meconium peritonitis. Progressive dilatation and decreased peristalsis of echogenic bowel were noted in the early part of the third trimester. Daily surveillance ultrasound was performed and spontaneous labour occurred at 32 weeks' gestation. A proactive postnatal approach guided by prenatal sonographic findings allowed prompt treatment and an urgent laparotomy was performed for an ileal volvulus with necrosis and meconium peritonitis. A segment of small bowel volvulus was resected and an end-to-end anastomosis was performed with uneventful recovery.
DISCUSSION
Clinically signs of fetal midgut volvulus are not pathognomonic, such as intestinal dilatation, abdominal mass, ascites, peritoneal calcifications, or polyhydramnios; thus, the diagnosis is often challenging. Complications reported in the literature include perforation and haemorrhagic ascites, which may lead to anaemia, hypovolemia, heart failure, and fetal demise.
CONCLUSION
This case highlights the importance of assessing the fetal bowel as a part of routine third trimester ultrasound. The case describes the complexity of diagnosis in the fetus, important considerations along with multidisciplinary team approach to management.
PubMed: 29854513
DOI: 10.1155/2018/5312179 -
BMC Pediatrics May 2018Meconium peritonitis is an infrequent congenital disease usually caused by perforation of the fetal digestive tract. Meconium peritonitis resulting from intrauterine... (Review)
Review
BACKGROUND
Meconium peritonitis is an infrequent congenital disease usually caused by perforation of the fetal digestive tract. Meconium peritonitis resulting from intrauterine appendiceal perforation has been rarely reported and is often overlooked during pregnancy. We herein report two cases of fetal appendiceal perforation.
CASE PRESENTATION
Two neonates were found to have intestinal distension and gradually increasing ascites antenatally. After birth, diagnostic abdominal punctures revealed meconium peritonitis. Urgent surgery showed both neonates had developed gangrenous appendicitis in utero. Pathological examination supported the diagnosis of fetal appendiceal perforation in both neonates, and one also had deformity of cecal duplication. In the present report, we also review the presentation, diagnosis, pathology, management, and recent literature of fetal appendiceal perforation.
CONCLUSION
Meconium peritonitis due to fetal appendiceal perforation is extremely rare, and preoperative diagnosis is almost impossible. However, clinicians should be aware of abnormal gastrointestinal manifestations in the fetus during the antenatal examination. For neonates with severe meconium peritonitis, an early operation with careful intraoperative exploration is necessary.
Topics: Appendicitis; Cecum; Humans; Infant, Newborn; Male; Meconium; Peritonitis
PubMed: 29751786
DOI: 10.1186/s12887-018-1133-8 -
Journal of Pediatric Surgery Oct 2018The aim of this study was to report our experience using the Bishop-Koop procedure for the treatment of various surgical problems of jejunoileal atresia including...
PURPOSE
The aim of this study was to report our experience using the Bishop-Koop procedure for the treatment of various surgical problems of jejunoileal atresia including luminal discrepancy, complex meconium peritonitis, type IIIb and type IV atresia which we defined as severe jejunoileal atresia.
METHODS
This retrospective study was performed on the patients with severe jejunoileal atresia who underwent Bishop-Koop procedure at a tertiary center in China over a five year of period. The mortality, complication rate, nutrition status and the risk factors for postoperative adverse outcomes were explored.
RESULTS
A total of 41 neonates underwent the Bishop-Koop procedure. The median duration of the hospital stay and total parenteral nutrition and the point at which oral feeding was initiated postoperatively were 24 days (95% CI =18.99-29.01), 13 days (95% CI = 9.03-16.97) and 11 days (95% CI = 10.17-11.83) respectively. The mortality rate was 7.32% (3/41). The complication rate was 41.4% (17/41) including anastomotic leak, intestinal obstruction, high output stoma and cholestasis. The weight for age Z-score at stoma closure was restored to normal levels (-0.86, 95% confidence interval (CI) = -1.44, -0.28). The main factor associated with adverse outcomes in severe jejunoileal atresia was premature delivery (odds ratio (OR) = 4.44, 95% CI = 1.06-18.67).
CONCLUSIONS
Bishop-Koop procedure appears to be a technically efficient method for severe jejunoileal atresia, although larger studies are needed to compare Bishop-Koop procedure and other operation techniques.
TYPE OF STUDY
Therapeutic.
LEVEL OF EVIDENCE
Level IV.
Topics: Digestive System Surgical Procedures; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Jejunum
PubMed: 29709288
DOI: 10.1016/j.jpedsurg.2018.03.027 -
Journal of Clinical Ultrasound : JCU Oct 2018Prenatal ultrasonography (US) in a 39 year-old woman revealed massive fetal ascites. A fetal abdomino-amniotic shunting procedure was performed. Subsequently, plain...
Omental calcification, necrotizing enterocolitis, and undescended testes after fetal abdomino-amniotic shunting performed for the management of meconium peritonitis: A case report.
Prenatal ultrasonography (US) in a 39 year-old woman revealed massive fetal ascites. A fetal abdomino-amniotic shunting procedure was performed. Subsequently, plain radiographs demonstrated diffuse gaseous distention of the bowel and multiple punctate calcifications in the left upper abdomen. Postnatal US examination showed multiple echogenic foci in the liver and the left upper abdomen, bowel wall thickening in the right-sided abdomen, and undescended testes. There was no intra-abdominal free air or loculated fluid collections. Medical management was instituted secondary to the clinical suspicion of omental calcification, necrotizing enterocolitis, and undescended testes. Follow-up US examination showed resolution of portal vein gas and bowel wall thickening. The neonate recovered fully.
Topics: Adult; Calcinosis; Cryptorchidism; Enterocolitis, Necrotizing; Female; Fetal Diseases; Fetal Therapies; Humans; Infant, Newborn; Male; Meconium; Omentum; Peritoneal Diseases; Peritonitis; Pregnancy; Ultrasonography, Prenatal
PubMed: 29574772
DOI: 10.1002/jcu.22589 -
The Turkish Journal of Pediatrics 2018Durmuş G, Boybeyi-Türer Ö, Gharibzadeh-Hizal M, Ekinci S, Kiper N. Meconium periorchitis: An incidentally diagnosed rare entity during inguinal herniorraphy. Turk J...
Durmuş G, Boybeyi-Türer Ö, Gharibzadeh-Hizal M, Ekinci S, Kiper N. Meconium periorchitis: An incidentally diagnosed rare entity during inguinal herniorraphy. Turk J Pediatr 2018; 60: 612-614. Meconium periorchitis (MPO) is a rare disorder caused by meconium peritonitis with the leakage of meconium into the scrotal sac through the patent processus vaginalis. MPO may be rarely detected during inguinal hernia repair. The association of MPO with cystic fibrosis is rarely seen. We present a male infant with the complaint of left groin swelling, compatible with reducible inguinal hernia. An herniotomy was carried out and the greenish nodules with calcifications were detected. Histopathological examination was compatible with MPO. Two months later the patient was diagnosed with atypical cystic fibrosis. Clinicians should be aware of MPO presentations and its appearance on the hernia sac to prevent unnecessary orchiectomy.
Topics: Cystic Fibrosis; Groin; Hernia, Inguinal; Herniorrhaphy; Humans; Incidental Findings; Infant; Infant, Newborn; Male; Meconium; Orchitis; Scrotum
PubMed: 30968646
DOI: 10.24953/turkjped.2018.05.025 -
Case Reports in Obstetrics and... 2017Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe...
Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome.
PubMed: 29230337
DOI: 10.1155/2017/7642784 -
Taiwanese Journal of Obstetrics &... Oct 2017
Topics: Fetal Diseases; Fetal Therapies; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Taiwan; Ultrasonography, Doppler; Ultrasonography, Prenatal
PubMed: 29037567
DOI: 10.1016/j.tjog.2017.08.024 -
Journal of Cystic Fibrosis : Official... Nov 2017Meconium ileus (MI) is often the first manifestation of cystic fibrosis (CF) and occurs in approximately 20% of patients diagnosed with CF. This article reviews the... (Review)
Review
Meconium ileus (MI) is often the first manifestation of cystic fibrosis (CF) and occurs in approximately 20% of patients diagnosed with CF. This article reviews the pathophysiology of MI and its clinical presentation. It focuses on the medical and surgical management emphasizing the importance of nutrition and a multidisciplinary approach to improve both short-term and long-term outcomes for CF patients with MI.
Topics: Cystic Fibrosis; Humans; Infant, Newborn; Meconium Ileus; Patient Care Management
PubMed: 28986020
DOI: 10.1016/j.jcf.2017.06.007 -
Clinical Radiology Feb 2018To use prenatal magnetic resonance imaging (MRI) to define features of meconium peritonitis (MP) and analyse the relationship between prenatal MRI findings and postnatal...
AIM
To use prenatal magnetic resonance imaging (MRI) to define features of meconium peritonitis (MP) and analyse the relationship between prenatal MRI findings and postnatal outcomes.
MATERIALS AND METHODS
Eight cases were enrolled who had been diagnosed with MP through prenatal MRI; the diagnoses were confirmed at surgery and pathology or follow-up. MP was diagnosed by the findings of meconium ascites, meconium pseudocyst, or dilated bowel loops. Prenatal follow-up after diagnosis by MRI was performed by ultrasound.
RESULTS
Prenatal MRI findings included massive meconium ascites (five out of eight cases), a small meconium pseudocyst (one out of eight), a large meconium pseudocyst along with a dilated bowel loop (one out of eight), a dilated bowel loop alone (one out of eight), and micro-colorectum (six out of eight). Six fetuses showed abdominal distension, bilious vomiting, and no normal meconium at birth; they underwent exploratory laparotomies and subsequently, survived and prospered. Only one fetus (with a small meconium pseudocyst) received conservative treatment. There was one mortality, and the cause of death was full-bowel necrosis.
CONCLUSION
Prenatal MRI may be helpful for diagnosing MP, in cases where the specific MRI findings are persistent meconium ascites, a dilated bowel loop, micro-colorectum, and meconium pseudocyst. In particular, a micro-colorectum might indirectly reflect ileum atresia, which requires postnatal surgery.
Topics: Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis
PubMed: 28954695
DOI: 10.1016/j.crad.2017.08.006 -
The American Surgeon Sep 2017
Topics: Gastric Bypass; Gastric Outlet Obstruction; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Pylorus; Radiography
PubMed: 30454353
DOI: No ID Found