PEDIATRIC SURGLCAL EMERGENCY AND ITS RADIOLOGICAL DIAGNOSIS

Abstract

Meconium peritonitis is an aseptic chemical peritonitis caused by spill of aseptic meconium in the peritoneal cavity due to perforation of the gut during the last 6 months of the gestation and early postnatal period. It has grave prognosis and only 15 survivors had been reported in Japanese literatures prior to 1975.A case of fibroadhesive type of the meconium peritonitis in a five-day-old male infant was presented. He was born in June 2, 1974. No abnormalities were found until he was in the 6th day of life, when he began to vomit bile stained fluid. He became distended by the next day and was transfered to the Gunma University Hospital. The scout film on admission (Fig. 1) revealed, a round calcium fleck in the subhepatic area with distended small bowel gas shadows. At laparotomy performed on the day of admission, dense calcified fibrous adhesions were found throughout the abdomen. No free perforation could be found. The adhesion was dissected out in the right lower abdomen and a side-to-side anastomosis was carried out between the bulbous distended portion of the small bowel and the terminal ileum. Immediate postoperative course was uneventful and he was discharged on June 26. However, he was readmitted on 83rd p.o. day in another hospital with fever and jaundice and died of an acute yellow liver atrophy caused by post-transfusion hepatitis on the 88th p.o. day. Hepatitis B antigen was demonstrated by an orcein method in the liver of the autopsied material.