Abstract
Giant cystic meconium peritonitis (GCMP) is an unusual and often fatal (>40%) form of neonatal peritonitis characterized by pseudocyst formation due to antenatal extravasation of meconium. This report documents survival in six consecutive neonates with GCMP managed according to data derived from both clinical and laboratory observations. All 6 full-term infants had abdominal distention at birth, vomited bile, and had abnormalities of meconium evacuation. Five were boys, and 3 had significant scrotal swelling. Abdominal x-rays showed a generalized ground-glass appearance in 3 infants, intraabdominal calcification in 4, and a large air-fluid level within a pseudocysts in 3. At laparotomy, all 6 had giant pseudocysts with free meconium, inflammatory membranes, and matted bowel. An ileal perforation was noted in 5 infants and, in 1 infant with cystic fibrosis, no perforation was identified. Evacuation of meconium, pseudocyst resection, debridement, and exteriorization of the perforation was done in 5 cases, and lysis of adhesions and decortication was performed in the patient with cystic fibrosis. All received antibiotics and parenteral nutrition. Stomal closure was subsequently accomplished at 7–16 wk. All 6 infants survived. Weanling rats were challenged with intraperitoneal low or high dose, sterile or infected meconium inoculation. One-half the animals in each group received antibiotics. Rats were evaluated for survival, abscess formation and peritoneal cellular response. High-dose nonsterile meconium inoculations were associated with the highest mortality, while antibiotics improved survival and prevented abscess formation in all groups. Our data suggests that early recognition, pseudocyst resection, decortication, temporary enterostomy, antibiotics, and meticulous postoperative care offer the best opportunity for survival in cases of GCMP.
Published Version
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