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

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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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Authors and Affiliations

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

    Pablo Caro-Domínguez & Alan Daneman

  2. Unidad de Imagen Pediátrica, Health Time, Hospital VIAMED Santa Ángela de la Cruz, Sevilla, Andalucía, Spain

    Pablo Caro-Domínguez

  3. Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Augusto Zani

  4. The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    David Chitayat

  5. Division of Clinical Genetics and Metabolism, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    David Chitayat

Authors
  1. Pablo Caro-Domínguez
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  2. Augusto Zani
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  3. David Chitayat
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  4. Alan Daneman
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Corresponding author

Correspondence to Alan Daneman.

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Caro-Domínguez, P., Zani, A., Chitayat, D. et al. Meconium peritonitis: the role of postnatal radiographic and sonographic findings in predicting the need for surgery. Pediatr Radiol 48, 1755–1762 (2018). https://doi.org/10.1007/s00247-018-4198-5

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  • DOI: https://doi.org/10.1007/s00247-018-4198-5

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