Giant cystic meconium peritonitis presenting in a neonate with classic radiographic eggshell calcifications and treated with an elective surgical approach: a case report

Erik R Barthel,Daniel E Levin,Tracy C Grikscheit,Allison L Speer,Bindi J Naik-Mathuria

doi:10.1186/1752-1947-6-229

Erik R Barthel, Daniel E Levin + Show 3 more

Open Access

https://doi.org/10.1186/1752-1947-6-229

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Abstract

IntroductionGiant cystic meconium peritonitis is relatively rare. Patients often present with nonspecific physical findings such as distension and emesis. Plain abdominal films remain invaluable for identifying the characteristic calcifications seen with a meconium pseudocyst, and large eggshell calcifications are pathognomonic for the giant cystic subtype.Case presentationWe present classic plain X-ray findings and an intraoperative image of a premature low birth weight two-day-old Hispanic male baby treated for giant cystic meconium peritonitis with a staged procedure involving peritoneal drainage, ostomy creation and closure.ConclusionPediatric surgeons have a range of potential therapeutic approaches for giant cystic meconium peritonitis. A delay of definitive surgical management in the setting of massive abdominal soiling is a safe and acceptable strategy if adequate temporizing drainage is performed in the early perinatal period.

Highlights

Giant cystic meconium peritonitis is relatively rare
Pediatric surgeons have a range of potential therapeutic approaches for giant cystic meconium peritonitis
Reports of meconium peritonitis appear in the Englishlanguage literature beginning in the early 20th century [1,2]

Summary

Conclusion

A classic appearance of large calcifications on plain abdominal films in the setting of a distended and distressed neonate should place giant cystic meconium peritonitis high upon the differential diagnosis. Initial peritoneal drainage with a delay in definitive surgical management is a reasonable approach in the setting of massive meconium soiling of the abdominal cavity that prohibits the safe identification of bowel loops for stoma creation. Consent Written informed consent was obtained from the patient’s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions ERB, ALS and DEL performed the literature search and wrote the manuscript. BJN-M and TG performed the surgeries, provided intraoperative images and critically reviewed the manuscript prior to submission. All authors have read and approved the final manuscript

Introduction

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