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Husain A, Naseem A, Anjum S, Imran S, Arifuzzaman M, Adil SO. Predictability of intrapartum cardiotocography with meconium stained liquor and its correlation with perinatal outcome. J PAK MED ASSOC 2018; 68:1014-1018. [PMID: 30317293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the relationship between the colour of liquor and the trace of cardiotocography to see whether it is reactive or non-reactive.. METHODS This cross-sectional study was conducted at Obstetrics and Gynaecology department, Dar-ul-Sehat Hospital, Karachi from June 2015 to March 2016, and comprised women in labour who delivered singleton babies and had >37 weeks of gestation. Intrapartum monitoring by cardiotocography was conducted. The status of the amniotic membranes, colour and amount of liquor observed were recorded. Cardiotocography was performed for 30 minutes in the left lateral position on admission as well as a monitoring tool in labour at an interval of less than 4 hours. Foetal heart transducer and uterine pressure transducers were applied and the readings were recorded. SPSS 21 was used for statistical analysis. RESULTS Of the total 200 subjects, 183(91.5%) were reactive and 17(8.5%) were non-reactive women. Overall mean age was 27.39±4.40 years. Most commonly noted risk factor were post-date 53(26.5%), anaemia 35(17.5%), premature rupture of membranes 28(14%) and pregnancy-induced hypertension 10(5%). Insignificant difference was observed in between Cardiotocography findings and risk factors of the women (p>0.05).. CONCLUSIONS Significant change was seen in cardiotocography of clear liquor which needs more evaluation to rule out ongoing hypoxia.
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Affiliation(s)
- Ayesha Husain
- Obstetrics and Gynecology Department, DarulSehat Hospital
| | - Aliya Naseem
- Obstetrics and Gynecology Department, DarulSehat Hospital
| | - Sagheera Anjum
- Obstetrics and Gynecology Department, DarulSehat Hospital
| | - Sajida Imran
- Obstetrics and Gynecology Department, DarulSehat Hospital
| | | | - Syed Omair Adil
- Department of Research, Dow University of Health Sciences, Karachi, Pakistan
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Chandrasekaran N, Benardete D, Cariello L, Meraz D. Prenatal sonographic diagnosis of meconium peritonitis from duodenal atresia. BMJ Case Rep 2017; 2017:bcr2017219208. [PMID: 28159774 PMCID: PMC5293971 DOI: 10.1136/bcr-2017-219208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | | | - Diego Meraz
- Cleveland Clinic Florida, Weston, Florida, USA
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3
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Terlizzi V, Sciarrone A, Cook AC, Botta G, Chiappa E. Extensive Myocardial Infarction in a Fetus With Cystic Fibrosis and Meconium Peritonitis. J Ultrasound Med 2016; 35:1826-1828. [PMID: 27462127 DOI: 10.7863/ultra.15.09037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Vito Terlizzi
- Cystic Fibrosis Center, Azienda Ospedaliero Universitaria Meyer Florence, Italy
| | - Andrea Sciarrone
- Prenatal Diagnosis Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin, Italy
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, England
| | - Gianni Botta
- Department of Fetal and Maternal Pathology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin, Italy
| | - Enrico Chiappa
- Department of Pediatric Cardiology, Azienda Ospedaliero Universitaria Meyer Florence, Italy
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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. Acad Radiol 2016; 23:559-68. [PMID: 26857524 DOI: 10.1016/j.acra.2015.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/09/2015] [Accepted: 12/27/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants. METHODS A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively. CONCLUSIONS There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair.
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Affiliation(s)
- A G Carroll
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - R G Kavanagh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - C Ni Leidhin
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - N M Cullinan
- Department of Pediatrics, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - L P Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - D E Malone
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
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Shiozaki A, Yoneda S, Iizuka T, Kusabiraki T, Ito M, Ito M, Yoneda N, Yoshimoto H, Saito S. Prenatal diagnosis of enterolithiasis at 18 weeks: multiple foci of intraluminal calcified meconium within echogenic bowel. J Med Ultrason (2001) 2014; 42:113-6. [PMID: 26578499 DOI: 10.1007/s10396-014-0561-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
Abstract
Enterolithiasis is an uncommon finding of a dilated hyperechogenic bowel with multiple ball-like echogenic structures at a routine prenatal check-up using ultrasonography. We here report a case of prenatally diagnosed enterolithiasis at 18 weeks of gestation, showing multiple hyperechogenic foci rolling within the bowel fluid after peristalsis. The size of the dilated bowel gradually increased during pregnancy. Magnetic resonance image demonstrated the dilated lower bowel with blind-ending rectum. A postnatal contrast medium study with retrograde urethrography revealed a middle imperforate anus and a rectourethral fistula. A careful examination, even before 20 weeks of gestation, is extremely useful in demonstrating intraluminal coarse calcifications within an echogenic bowel.
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Affiliation(s)
- Arihiro Shiozaki
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Satoshi Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takashi Iizuka
- Department of Obstetrics and Gynecology, Saiseikai Takaoka Hospital, 387-1 Futazuka, Takaoka, 933-8525, Japan
| | - Tae Kusabiraki
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Masami Ito
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Mika Ito
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hideo Yoshimoto
- Department of Obstetrics and Gynecology, Saiseikai Takaoka Hospital, 387-1 Futazuka, Takaoka, 933-8525, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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Charlagorla P, Sublett S, Sy F, Kessler E, Gad A. Fetal intestinal perforation and meconium peritonitis associated with maternal autoimmune hepatitis. J Neonatal Perinatal Med 2014; 7:71-74. [PMID: 24815708 DOI: 10.3233/npm-1471113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Autoimmune hepatitis (AIH) in pregnancy can affect both fetal and maternal outcomes. Little is known regarding the fetal outcomes of AIH in pregnancy. The major risks include spontaneous abortions, fetal mortality, perinatal mortality and prematurity. Two common drugs used in the management of AIH, azathioprine and prednisone, may also be associated with adverse fetal outcomes. We present the case of perinatal focal intestinal perforation with a meconium pseudocyst in a preterm infant of a mother with autoimmune hepatitis on azathioprine and methylprednisone.
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Affiliation(s)
- P Charlagorla
- Department of Pediatrics, New York Methodist Hospital, Brooklyn, NY, USA
| | - S Sublett
- Saint George's University School of Medicine, True Blue, Grenada
| | - F Sy
- Department of Pediatrics, New York Methodist Hospital, Brooklyn, NY, USA
| | - E Kessler
- Department of Surgery, New York Methodist Hospital, Brooklyn, NY, USA
| | - A Gad
- Department of Pediatrics, New York Methodist Hospital, Brooklyn, NY, USA
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Lee JH, Im SA, Lee G. Evolution of sonographic findings in a fetus with ileal atresia. J Clin Ultrasound 2011; 39:359-62. [PMID: 21544826 DOI: 10.1002/jcu.20824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 02/22/2011] [Indexed: 05/10/2023]
Abstract
We report a case of a meconium pseudocyst secondary to ileal atresia and midgut volvulus. Initially, a single anechoic cyst was detected on prenatal sonography. The cyst gradually increased in size during the second trimester and eventually appeared as a large mass in the lower abdomen with echogenic content and associated with bowel dilatation. This case indicates that until the mid third trimester a single sonolucent cyst without signs of bowel obstruction may be associated with congenital intestinal obstruction.
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Affiliation(s)
- Jung-Hyun Lee
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
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Izumi Y, Sato Y, Kakui K, Tatsumi K, Fujiwara H, Konishi I. Prenatal treatment of meconium peritonitis with urinary trypsin inhibitor. Ultrasound Obstet Gynecol 2011; 37:366-368. [PMID: 20878676 DOI: 10.1002/uog.8843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2010] [Indexed: 05/29/2023]
Abstract
We describe a case of congenital meconium peritonitis with progressive fetal ascites and polyhydramnios. Fetal ascites could be only partially reduced on paracentesis at 29 weeks' gestation, and it subsequently increased. Urinary trypsin inhibitor (UTI), a physiological anti-inflammatory substance, was administered into the fetal abdominal cavity at a second paracentesis performed at 35 weeks' gestation. There was a significant amount of fetal ascites remaining 1 day after the second paracentesis, but this completely resolved within 5 days. A healthy infant was delivered vaginally and no surgical intervention was required. The case suggests that UTI can reduce meconium-induced chemical peritonitis and thereby facilitate intrauterine remission of fetal ascites.
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Affiliation(s)
- Y Izumi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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9
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Markov D, Jekova N, Ivanov S, Diavolov V, Brankov O. [Fetal meconium pseudocyst secondary to in utero perforation of colon transversum and meconium peritonitis]. Akush Ginekol (Sofiia) 2011; 50:46-51. [PMID: 21695944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fetal bowel intrauterine perforation causes sterile inflammation of the peritoneum, known as meconium peritonitis. In some cases the perforation closes spontaneously, thus forming a meconium pseudocyst between the intestinal loops and the omentum. Meconium peritonitis, complicated by pseudocyst formation, should always be considered when a fetal abdominal mass with diverse echogenicity and hyperechogenic calcifications is observed on prenatal ultrasound. Usually, this is associated with ascites and/or polyhydramnios. The differential diagnosis necessitates exclusion of all other fetal abdominal tumors. We present a case report of meconium pseudocyst diagnosed prenatally at 32 weeks of gestation which was successfully treated by surgery after birth.
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Dewan P, Faridi MMA, Singhal R, Arora SK, Rathi V, Bhatt S, Aggarwal SK. Meconium peritonitis presenting as abdominal calcification: three cases with different pathology. Ann Trop Paediatr 2011; 31:163-7. [PMID: 21575323 DOI: 10.1179/1465328111y.0000000001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intra-abdominal calcification is uncommon in newborns and has several causes of which meconium peritonitis is the most frequent. Three neonates with intra-abdominal calcification as a complication of meconium peritonitis are presented. The types of meconium peritonitis were cystic, meconium pseudocyst and meconium ascites. Two required surgical intervention. Meconium peritonitis should be considered in newborns with intra-abdominal calcification.
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Affiliation(s)
- P Dewan
- Department of Paediatrics, University of Delhi, India.
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Affiliation(s)
- Cerine Jeanty
- Wayne State University School of Medicine, Detroit, Michigan, USA
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12
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Copeland DR, St Peter SD, Sharp SW, Islam S, Cuenca A, Tolleson JS, Dassinger MS, Little DC, Jackson RJ, Kokoska ER, Smith SD. Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg 2009; 44:2130-2. [PMID: 19944221 DOI: 10.1016/j.jpedsurg.2009.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 05/28/2009] [Accepted: 06/01/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE Contrast enema is the initial study of choice for simple meconium ileus to confirm diagnosis and to relieve obstruction. Despite favorable historically published results, our clinical impression suggests decreased effectiveness of the contrast enema resulting in more surgical interventions in contemporary practice. METHODS A retrospective multiinstitutional review for a 12-year period was conducted for neonates diagnosed with meconium ileus by contrast enema. The neonates were divided into 2 groups-historic group (HG = before 2002) and contemporary group (CG = after 2002). T test was used for comparison of continuous variables and chi(2) for categorical data. RESULTS Thirty-seven total patients were identified (21 females and 16 males). Obstruction was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the CG group was 5.5% (1/18) compared to 39% (7/18) in HG. CONCLUSIONS In this review, success of contrast enema for relief of meconium ileus has significantly decreased over time. These findings may be because of reluctance to repeat enemas, change in radiologist experience, or use of contrast agent. As a result, higher rates of operative intervention are now observed. In stable patients, surgeons should recommend repeat enemas before exploration.
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Lubusky M, Prochazka M, Dhaifalah I, Horak D, Geierova M, Santavy J. Fetal enterolithiasis: prenatal sonographic and MRI diagnosis in two cases of urorectal septum malformation (URSM) sequence. Prenat Diagn 2006; 26:345-9. [PMID: 16566038 DOI: 10.1002/pd.1415] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Enterolithiasis (multiple calcifications of intraluminal meconium) is a rare, prenatal ultrasonographic finding. In this study, our aim was to evaluate the prenatal diagnostic features and discuss the management of the patients. METHODS The data of two cases of prenatally diagnosed fetal enterolithiasis were collected from ultrasound scan, magnetic resonance imaging (MRI) and neonatal or postnatal autopsy records. The findings were evaluated in both prenatal and postnatal periods. Chromosomal analysis was performed in one case. An evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for via radiology, neonatal surgery and histopathology. RESULTS Malformations in two cases (both males) with partial and complete urorectal septum malformation (URSM) sequence were described. The absence of an anal opening and presence of a fistula between the urinary and gastrointestinal tract were common findings. These features were considered as primary malformations contributing to the formation of enterolithiasis. Secondary anomalies (urinary and gastrointestinal system malformations, pulmonary hypoplasia, genital and other coexisting anomalies) were evaluated. CONCLUSIONS The prenatal detection of enterolithiasis carries a poor prognosis. Most of the previously reported cases were invariably associated with major fetal malformations of the urinary and gastrointestinal tract. It is a warning sign for large bowel obstruction with or without enterourinary fistula. Therefore, adequate gastrointestinal and urologic studies must be undertaken after birth for the final diagnosis. There is a high mortality rate in the reported cases, mostly attributed to associated anomalies, and all survivors required neonatal surgery. It is important to differentiate the partial from the full URSM sequence because the prognosis in the partial URSM sequence is generally good, with long-term survival being common.
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Affiliation(s)
- Marek Lubusky
- Department of Obstetrics and Gynecology, University Hospital, Olomouc, Czech Republic.
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14
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Affiliation(s)
- Pankaj Kalra
- Department of Urology, University of Illinois, Chicago, Illinois 60561, USA
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15
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Cowles RA, Berdon WE, Holt PD, Buonomo C, Stolar CJ. Neonatal intestinal obstruction simulating meconium ileus in infants with long-segment intestinal aganglionosis: radiographic findings that prompt the need for rectal biopsy. Pediatr Radiol 2006; 36:133-7. [PMID: 16341713 DOI: 10.1007/s00247-005-0043-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 09/08/2005] [Accepted: 09/27/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The initial clinical presentation and radiographic finding of microcolon in children with long-segment intestinal aganglionosis involving the entire colon, ileum and sometimes the jejunum can mimic meconium ileus. This makes the diagnosis difficult for the radiologist and surgeon. OBJECTIVE To document and describe the clinical and radiographic findings in children with long-segment intestinal aganglionosis who are initially thought to have meconium ileus. MATERIALS AND METHODS We reviewed the cases of six neonates with long-segment intestinal aganglionosis presenting as meconium ileus at our institutions between 1978 and 2002. We examined the clinical presentation and the radiographic, surgical, and pathologic findings. In addition, 17 cases from the literature were identified and are included in the discussion. RESULTS A total of 23 cases were reviewed. Right lower quadrant intraluminal calcifications were noted on abdominal radiographs in all six neonates of our series and were described in 13 of the 17 neonates reported in the literature. Similarly, a microcolon was present in five of the six neonates of our series and in 14 of 16 historical neonates (one not reported). CONCLUSION In a neonate with small-bowel obstruction and a microcolon, the presence of right lower quadrant intraluminal calcifications should raise the suspicion of long-segment intestinal aganglionosis even if the operative findings are typical of meconium ileus and a biopsy should be performed.
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Affiliation(s)
- Robert A Cowles
- Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, 3959 Broadway, Rm. CHN216B, New York, NY 10032, USA.
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Navarro OM, Daneman A, Miller SF. Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction. Pediatr Radiol 2004; 34:1020-3. [PMID: 15375640 DOI: 10.1007/s00247-004-1294-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 07/05/2004] [Accepted: 07/09/2004] [Indexed: 10/26/2022]
Abstract
About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery.
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Affiliation(s)
- Oscar M Navarro
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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17
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Affiliation(s)
- Thomas E Herman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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18
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Sergent F, Marret S, Verspyck E, Liard A, Labadie G, Marpeau L. [Management of meconium peritonitis: a remarkable case of idiopathic meconium peritonitis diagnosed antenatally]. J Gynecol Obstet Biol Reprod (Paris) 2003; 32:575-81. [PMID: 14593305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Meconium peritonitis is an inflammatory peritonitis induced by meconium extruding into the peritoneal cavity through a perforation of the fetal intestine. Antenatal diagnosis is possible. Prognosis depends on the pathology having caused perforation. This is often unknown. The objectives of this article are to analyze the contribution of antenatal investigations to estimating neonatal prognosis of meconium peritonitis, and to define optimal management. We describe a case of meconium peritonitis diagnosed in utero with particularly severe ultrasound presentation suggesting a potentially lethal course for the neonate. An eutrophic infant was delivered vaginally after preliminary aspiration of the meconium ascites. The neonate presented with a very distended abdomen and responded well to neonatal resuscitation. Laparotomy exploration confirmed the diagnosis of meconium peritonitis. No cause was identified. No obvious perforation was found. The postsurgery period was uneventful. At later follow-up the infant was doing well, free of further problems notably of any digestive disorder. Antenatal ultrasound features suggestive of severe meconium peritonitis are distended fetal bowel loops, huge cystic masses, major meconium ascites, and polyhydramnios. These neonates have a high risk of obstruction and intestinal perforation. Intestinal resection is frequently required. Cardiopulmonary resuscitation is necessary more often in these neonates with a higher risk of fatal outcome due to respiratory distress syndrome or surgery complications. Prognosis remains good after antenatal diagnosis for neonates free of cystic fibrosis, providing delivery takes place in a center with adequate technical facilities.
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Affiliation(s)
- F Sergent
- Clinique Gynécologique et Obstétricale, Pavillon Mère-Enfant, Hôpital Charles-Nicolle, 76031 Rouen Cedex.
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Tan HH, Tan VC, Yeo GS. A case series of gastrointestinal abnormalities in fetuses with echogenic bowel detected during the antenatal period. Ann Acad Med Singap 2003; 32:649-52. [PMID: 14626795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE The objective was to evaluate the incidence of gastrointestinal abnormalities amongst those fetuses with antenatally diagnosed echogenic bowel (EB). MATERIALS AND METHODS A retrospective review of all cases delivered from April 2002 to March 2003 with antenatally diagnosed EB was conducted. This was defined as bowel that appeared as echogenic as (if not greater than) the iliac bone on a real-time image. The postnatal outcomes with regard to gastrointestinal abnormalities, till their discharge, were noted. RESULTS Of the 13,941 patients delivered, there were 70 cases with antenatally diagnosed EB, giving an incidence of 70/13,941 or 0.50%. Of these, 6 defaulted follow-up and 1 had a mid-trimester termination of pregnancy at 21 weeks' gestation for social reasons. Of the remaining 63 cases with EB, 2 were stillbirths at 31 weeks and 35 weeks of gestation, respectively. Three fetuses (3/63 or 4.76%) were diagnosed with gastrointestinal abnormalities. Meconium plug syndrome was diagnosed postnatally in 2 cases, of which, 1 resolved with conservative management while the other required an emergency laparotomy. Intestinal atresia was diagnosed in the postmortem of one of the stillbirths. There was evidence of intrauterine growth retardation (IUGR) in both the stillbirth and the fetus that had required laparotomy. None of the 3 fetuses exhibited clinical features of aneuploidy. CONCLUSION As the quoted background risk for gastrointestinal pathology is 0.23%, an increased incidence (4.76%) is observed in those fetuses found to have antenatal EB. It is possible that the presence of IUGR is associated with a worse prognosis. Further prospective studies are needed to verify this association.
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Affiliation(s)
- H H Tan
- Department of Maternal Fetal Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore 229899
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Abstract
Intra-abdominal cystic lesions are increasingly recognized in the newborn because of the advent of routine antenatal ultrasonography. As these lesions are often asymptomatic or non-specific in clinical presentation in the newborn, imaging by ultrasonography has an important role in diagnosis. We present a pictorial review of the commonly encountered intra-abdominal cystic lesions in the newborn, with emphasis on ultrasonographic features that can aid differentiation between the various lesions.
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Affiliation(s)
- P L Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People's Republic of China.
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Affiliation(s)
- A Das
- Department of Neonatology, Our Lady Of Lourdes Hospital, Drogheda, Ireland
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Orgad S, Berkenstadt M, Achiron R, Yahav Y, Gazit E, Barkai G, Loewenthal R. Hyperechogenic bowel loops and meconium ileus in a fetus carrying the D1152H and G542X cystic fibrosis CFTR mutations. Prenat Diagn 2002; 22:636-7. [PMID: 12124706 DOI: 10.1002/pd.362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Su WH, Lin JY, Yuan CC, Wang PH. Prenatal diagnosis of meconium peritonitis in twin pregnancy after intracytoplasmic sperm injection. J Reprod Med 2001; 46:697-8. [PMID: 11499193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
We present 4 cases of fetal intestinal obstruction and their ultrasonographical findings. With regard to the reported cases we discuss the diagnostic and differential-diagnostic considerations of this rare but not uncommon fetal malformation.
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Affiliation(s)
- R Müller
- Johanniter Frauen- und Kinderklinik Stendal
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Abstract
A neonate with ileal atresia (IA) complicated by meconium peritonitis (MP) whose prenatal ultrasonography (US) detected an intrauterine intussusception (IUI) is reported. Fetal ascites, dilated bowel loops, and abdominal calcifications were identified on serial US from 25 weeks of gestation. Intestinal loops with high echogenecity and a "target-like" appearance suggestive of IUI were detected in the right lower quadrant. The 2,680-g male was delivered vaginally at term and underwent a laparotomy. Fibrous adhesions and small calcifications were scattered throughout the peritoneal cavity. IA (interrupted type) was confirmed 17.0 cm cranial to the ileocecal valve (ICV). An ileo-ileal intussusception was also found between 16.5 cm and 9.0 cm cranial to the ICV. Partial resection of the ileum and an ileo-ileal anastomosis was performed. The postoperative course was uneventful. In this case, the pathological process of IUI resulting in IA and MP was demonstrated sonographically by identifying the "target-like" appearance in the fetus.
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Affiliation(s)
- T Shimotake
- Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan
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Abstract
PURPOSE This study aimed to determine the clinical significance of echogenic amniotic fluid. METHODS We prospectively studied 19 twin pregnancies in which the amniotic fluid in 1 sac was anechoic and that in the other sac was echogenic. Morphologic characteristics of amniotic fluid were assessed from samples taken at amniocentesis or upon delivery within 48 hours after sonographic examination. RESULTS In twins with echogenic amniotic fluid, assessment revealed clear fluid in 6 cases (32%), vernix caseosa in 12 (63%), and meconium in 1 (5%). In co-twins with anechoic amniotic fluid, assessment revealed clear fluid in 9 cases (47%), vernix caseosa in 6 (32%), and meconium in 4 (21%). CONCLUSIONS Echogenic amniotic fluid on prenatal sonography is not predictive of meconium.
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Affiliation(s)
- B Petrikovsky
- Division of Maternal Fetal Medicine, North Shore University Hospital, New York University School of Medicine, Manhasset 11030, USA
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Ohmichi M, Kanai H, Kanzaki T, Matumoto K, Neki R, Chiba Y, Kamata S, Murata Y. Meconium peritonitis: changes in fetal C-reactive protein and CA 125 levels in relation to stage of disease. J Ultrasound Med 1997; 16:289-292. [PMID: 9315159 DOI: 10.7863/jum.1997.16.4.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M Ohmichi
- Department of Obstetrics and Gynecology, Osaka University Medical School, Japan
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Neal MR, Seibert JJ, Vanderzalm T, Wagner CW. Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia. J Ultrasound Med 1997; 16:263-268. [PMID: 9315154 DOI: 10.7863/jum.1997.16.4.263] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Meconium ileus can be difficult to distinguish from ileal atresia on plain radiographs and on contrast enema. Both show a microcolon in the face of a small bowel obstruction. The treatment of the two is very different. Meconium ileus obstruction may be relieved medically by contrast enema; ileal atresia requires prompt surgical intervention. This study was made to determine if abdominal ultrasonography might be helpful in distinguishing between these two entities. Abdominal ultrasonograms from the past 10 years of all patients with these two diseases who were studied with preoperative ultrasonography at Arkansas Children's Hospital were reviewed. Six of 16 patients with meconium ileus had preoperative ultrasonograms. All six patients with meconium ileus had multiple loops of bowel filled with very echogenic thick meconium. Four of 22 patients with ileal atresia had preoperative ultrasonograms. These four patients with ileal atresia had dilated loops of bowel filled with fluid and air. None had a dilated bowel filled with thick echogenic contents. Preoperative abdominal ultrasonography is proposed as a simple method for distinguishing between these two disease entities with very different treatment plans.
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Affiliation(s)
- M R Neal
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, USA
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Affiliation(s)
- L Grimaldi
- Department of Radiology, Millard Fillmore Hospital, Williamsville, New York
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30
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Bruno M, Rocco V, Pastore AR. [A case of meconium peritonitis]. Minerva Ginecol 1994; 46:369-71. [PMID: 7936391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of meconium peritonitis that was diagnosed ultrasonographically in the second trimester is presented. Fetal ascites, intra-abdominal calcification and polyhydramnios were detected on antenatal ultrasonography.
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Affiliation(s)
- M Bruno
- Divisione di Ostetricia e Ginecologia, USL 3, Ospedale Landolfi, Solofra, Avellino
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31
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Affiliation(s)
- M Mene
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA 19141-3098
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Brown DL, Polger M, Clark PK, Bromley BS, Doubilet PM. Very echogenic amniotic fluid: ultrasonography-amniocentesis correlation. J Ultrasound Med 1994; 13:95-97. [PMID: 7932968 DOI: 10.7863/jum.1994.13.2.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Very echogenic amniotic fluid has been variably attributed to meconium, blood, or vernix caseosa. However, most previous reports have been case reports, and most cases have not had proof by amniocentesis. In a larger series of patients with proof by amniocentesis, we sought to determine the relative frequency of these substances as causes of very echogenic amniotic fluid. We retrospectively identified obstetric sonograms in which the amniotic fluid was homogeneously filled with innumerable echogenic particles. The cause of the increased echogenicity was determined by fluid appearance at amniocentesis. Of 86 cases identified, immediate proof by amniocentesis was available in 19 patients for whom the gestational age ranged from 32.8 to 39.4 weeks. Vernix was present in 18 (95%) patients and meconium in one (5%) patient. Very echogenic amniotic fluid in the third trimester is most often due to vernix and infrequently due to meconium. This sonographic finding is not a reliable indicator of meconium or blood in amniotic fluid and should not typically alter antenatal management.
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Affiliation(s)
- D L Brown
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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Hogge WA, Hogge JS, Boehm CD, Sanders RC. Increased echogenicity in the fetal abdomen: use of DNA analysis to establish a diagnosis of cystic fibrosis. J Ultrasound Med 1993; 12:451-454. [PMID: 8411328 DOI: 10.7863/jum.1993.12.8.451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The sonographic finding of increased echogenicity within the fetal abdomen presents a diagnostic dilemma, with a differential diagnosis ranging from normal variation to CF. We report the diagnostic evaluation of four cases, two of which were found to be the result of CF. On the basis of this experience, we believe that persistence of an echogenic bowel pattern, especially with bowel dilation, after 20 weeks' gestation should prompt an evaluation for CF. Using DNA analysis, approximately 75% of the cases involving CF can be detected with noninvasive studies of the parents, and confirmation by amniocentesis is performed only in those cases in which both parents are carriers of known mutations.
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Affiliation(s)
- W A Hogge
- Department of Obstetrics and Gynecology, University of Maryland
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Sukcharoen N. Prenatal sonographic diagnosis of meconium peritonitis: a case report. J Med Assoc Thai 1993; 76:171-176. [PMID: 8228714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A case of meconium peritonitis that was diagnosed ultrasonographically in the third trimester is presented. Fetal ascites, intra-abdominal calcification, left communicating hydrocele, and polyhydramnios were detected on antenatal ultrasonography. Specks of calcification were also demonstrated on abdominal radiography postnatally. Laparotomy confirmed the diagnosis of perforated terminal ileum with meconium peritonitis. The obstetric and neonatal implications of meconium peritonitis are discussed with literature review.
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Affiliation(s)
- N Sukcharoen
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Soong JH, Hsieh CC, Chiu TH, Kuo DM, Chen FP, Lo LM, Soong YK. Meconium peritonitis-antenatal diagnosis by ultrasound. Changgeng Yi Xue Za Zhi 1992; 15:155-60. [PMID: 1468039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Meconium peritonitis is usually the result of prenatal bowel obstruction with subsequent perforation, then the contents spread into the peritoneal cavity, which results in a sterile inflammatory reaction. The incidence ranges from 1/1500 to 1/2000, if without prenatal diagnosis and planned postnatal treatment, the mortality rate is as high as 62%. We describe three children, two with surgically, one with autoptically confirmed meconium peritonitis. All had abnormally prenatal ultrasonographic examinations. The first fetus showed a large 10 x 11 cm intra-abdominal mass with floating echogenic substances inside and with an echogenic rim. The second showed increased echogenicity with dilated bowel in abdominal cavity in one of the twin, and the third had an intra-abdominal cyst with several echogenic bands inside, fetal ascites was also noted. It is remarkable that the ultrasonographic findings were different in the three children. Two of the three children survived postoperation, one died 3 hours later after induction out at 31 weeks of gestational age due to multiple congenital anomalies.
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Affiliation(s)
- J H Soong
- Department of Obstetrics & Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Deka D, Buckshee K, Bhatnagar V. Prenatal diagnosis of pre-sacral mass, simulated by meconium. Indian J Pediatr 1991; 58:388-9. [PMID: 1937657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hussain SM, Meradji M, Robben SG, Hop WC. Plain film diagnosis in meconium plug syndrome, meconium ileus and neonatal Hirschsprung's disease. A scoring system. Pediatr Radiol 1991; 21:556-9. [PMID: 1815174 DOI: 10.1007/bf02012596] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abdominal plain films of 133 neonates, with 82 cases of meconium plug syndrome (MPS), 27 cases of meconium ileus (MI) and 24 cases of neonatal Hirschsprung's disease (HD), were reviewed to assess the value of such radiographs for diagnosis. The radiographs were examined according to a list of 11 parameters. By using multivariate discriminant analysis, it appeared that 4 parameters i.e. dilatation of bowel loops, varying loop calibre, fluid levels and colonic gas were most important in discriminating among the three disorders. For each parameter the weight (in points) was derived. To classify patients, three group-scores had to be calculated: the group-score with the largest value indicated the most likely disorder. So in 99%, 88% and 63% of MPS, HD and MI, respectively, an accurate diagnosis could be predicted. The overall diagnostic accuracy was 89%. Such a diagnosis can be a sound basis for further investigation.
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Affiliation(s)
- S M Hussain
- Department of Pediatric Radiology, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands
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Roscioli B, Bassetti D. [A case of meconial peritonitis with favorable spontaneous evolution]. Pathologica 1969; 61:255-9. [PMID: 5408519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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