Midgut volvulus and meconium peritonitis induced non-immune hydrops

Abstract

Meconium peritonitis (MP) is a rare cause of nonimmune hydrops and only few of those cases have been reported in literature. Here is to report on a case of FH secondary to perforated midgut volvulus and MP with special interest in the discussion of pathophysiology and clinical strategies. We report on a preterm male neonate diagnosed with FH at 29th week of gestational age (WGA) and EXIT at 30 WGA. In addition, he presented with abdominal mass, respiratory distress syndrome and hypoglycemia. Emergent endotracheal intubation and mechanical ventilation rescued the baby. All maternal and infant viral panel, Toxoplasmosis, Sars-Covid 2 and indirect/direct coombs tests were negative. . At laparotomy, we found a midgut volvulus interesting nearly all the jejunum but sparing the ileum which appeared hypoplastic. One of intestinal loop was completely perforated with diffuse MP. Distal to the first jejunal loop, the jejunum appeared necrotic and then resected with bowel exteriorization (terminal jejunostomy and ileostomy). The postoperative course was complicated by worsening of respiratory distress, acute tubular necrosis and renal failure unresponsive to medical therapy and fatal outcome. In conclusion, we believe that hydrops secondary to midgut volvulus and meconium peritonitis has its own pathophysiological and clinical characteristics that make this disease at high risk of unfavourable outcome when compared with prenatal cases of midgut and/or meconium peritonitis without hydrops.