Meconium peritonitis: the role of postnatal radiographic and sonographic findings in predicting the need for surgery.

Pediatr Radiol

Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.

Published: November 2018

AI Article Synopsis

  • The study investigates how postnatal imaging techniques (radiography and sonography) can help predict which newborns with meconium peritonitis need surgical intervention.
  • A review of cases from 1999 to 2014 showed that 62% of the 37 neonates studied required surgery, with bowel obstruction and ascites being key indicators for surgical needs.
  • While certain imaging findings like intestinal obstruction and pneumoperitoneum were linked to the necessity for surgery, neonates with meconium pseudocysts had a significant chance of being treated without surgery.

Article Abstract

Background: The role of imaging in meconium peritonitis is not limited to establishing a diagnosis; rather, it might also be helpful in determining which neonates require surgery. However, few data in the literature correlate the postnatal radiographic and sonographic findings with the need for surgery.

Objective: To compare the role of postnatal radiographic and sonographic findings in predicting the need for surgery in neonates with meconium peritonitis.

Materials And Methods: We conducted a retrospective analysis of clinical, imaging and surgical findings in all neonates with meconium peritonitis in the period 1999-2014. We divided the children into operative or non-operative groups and then correlated each group with the presence or absence of the following findings on both the radiographs and sonograms: peritoneal calcification, meconium pseudocyst, intestinal obstruction, volvulus, ascites and pneumoperitoneum.

Results: Thirty-seven neonates (22 males, 15 females) had meconium peritonitis in this period, of whom 23 (62%) required surgery and 14 (38%) were successfully treated non-surgically. None had an antenatal infection and three had cystic fibrosis (8%). Bowel obstruction identified on radiography (12/23, P=0.01) and sonography (9/23, P=0.04) and ascites identified with sonography (7/23, P=0.01) were associated with the need for surgical intervention. The presence of pneumoperitoneum and volvulus were also associated with surgical intervention. There was no significant statistical difference in the number of neonates with diffuse peritoneal calcification who were treated operatively or non-operatively. Four (33%) of the 12 neonates with meconium pseudocysts were successfully treated non-operatively.

Conclusion: Imaging findings that predicted the need for surgery were intestinal obstruction, ascites, volvulus and pneumoperitoneum. Neonates with meconium pseudocysts did not require surgery if they were not associated with the described findings. The findings in our patients also indicate that those with diffuse peritoneal calcification as an isolated finding can be successfully treated non-operatively.

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Source
http://dx.doi.org/10.1007/s00247-018-4198-5DOI Listing

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