2009-11-24-10 Jejunal obstruction and meconium peritonitis © Al-asali www.thefetus.net/
Jejunal obstruction and meconium peritonitis
Othman Al-Asali, MD*, Daad Karuot, MD*, Manal Al-Hakeem, MD**.
* Maternity Department, Al-Hammadi Hospital, Riyadh, Saudi Arabia;
** Department of Radiology, Al-Hammadi Hospital, Riyadh, Saudi Arabia.
The following images represent a case of meconium peritonitis caused by meconium obstruction of the jejunum. A 26-year-old G10 P2 with a personal history of the systemic lupus erythematosus was first presented to our department at the 6 weeks of pregnancy. She was put on the LMWH (low molecular weight heparin) and aspirin therapy since her first visit. Her family history was positive for hypertension and diabetes.
The ultrasound examination at the 10th week of pregnancy was normal. The subsequent ultrasound examination was done at the 24+2 weeks. It showed moderate amount of the free fluid in the fetal abdomen cavity, ascites and hyperechogenic bowel. No other anomalies were detected during the ultrasound examination.
The ultrasound examination at the 31+5 weeks showed distended fetal bowel up to 24 mm in diameter and mild ascites. The images were suggestive of the bowel obstruction.
The ultrasound examination at 34 weeks revealed even more severe bowel dilation, bowel measured up to 32 mm.
We induced labor at 38 weeks of gestation. The delivery was performed via emergency cesarean section due to a fetal hypoxia. The neonate had an apparent distension of the abdomen. When we inserted a nasogastric tube to the neonate"s stomach, it drained a bilious fluid. An enema with a contrast medium revealed the obstruction in the distal ileum. The neonate underwent surgery. There were marked intestinal adhesions and meconium plug obstructing the distal jejunum. There were multiple meconium stones found in the distal jejunum. The affected part of the jejunum was removed and jejunostomy was performed.
intrabdominal echogenic areas
Images 1,2: Images show a transverse view of the fetal abdomen, note apparent ascites.
Images 3,4: Images show a sagittal view of the fetal abdomen and thorax, note the echogenic bowel.
Images 5,6: Images show a dilated bowel with an anechogenic content.
Images 7-14: Images show a dilated bowel, up to 32 mm.
Image 15: Image shows a neonate after delivery with a nasogastric tube derivating a bilious content, note the abdominal distension.
Images 16,17: Image 16 shows a X-ray image of the abdomen taken 10 hours after delivery. Image 17 shows a contrast medium enema suggesting the iliac obstruction.
Images 18,19: Images taken during the surgery show a dilated jejunum and adhesions.
Images 20, 21: Images show a dilated jejunum with inflammatory changes.