Meconium Peritonitis Connecting the Dots between Pathophysiology, Prenatal Diagnosis and Postnatal Outcome

Abstract

Abstract
Objective: To describe the antenatal findings, clinical course, and perinatal outcome of a case of meconium peritonitis.
Methods: This is a case report.
Case: A 28-year-old primigravida at 34–35 weeks’ gestation was referred for evaluation of hyperechoic fetal bowel. Serial
ultrasonography revealed echogenic bowel and fetal ascites without associated major structural anomalies. Maternal serology
showed reactive IgG for toxoplasma and cytomegalovirus with high avidity, suggesting past infection. Based on the Zangheri
classification, the condition was categorized as grade I meconium peritonitis. The patient delivered at term (38–39 weeks).
The female neonate weighed 2,640 g, with a length of 50 cm and APGAR scores of 8 and 9 at 1 and 5 minutes, respectively.
Postnatal evaluation revealed no signs of acute abdomen. Babygram findings were unremarkable. The neonate was diagnosed
with meconium peritonitis and early-onset sepsis and received empirical antibiotic therapy for 6 days, resulting in clinical
improvement.
Conclusion: Meconium peritonitis presents with a spectrum of antenatal findings, including intra-abdominal calcifications,
ascites, pseudocyst formation, and bowel dilatation. The Zangheri classification is useful for predicting disease severity and the
likelihood of postnatal surgical intervention. Mild cases may resolve spontaneously in utero, allowing for favorable outcomes
with conservative management and term delivery.
Keywords: Meconium peritonitis, prenatal diagnosis, ultrasonography.