Perforated Meckel's diverticulum in a very preterm baby revealed at birth.

Perforated Meckel's diverticulum (MD) in a preterm baby is very rare. We report a case of a very preterm baby, born at 29-week gestation, with a birth weight of 1400 g, admitted in the third hour of life to our intensive care unit (ICU) for respiratory distress syndrome with abdominal distention. An abdominal radiograph showed a pneumoperitoneum. Laparotomy revealed Meckel's perforation. The baby was discharged healthy at the age of 16 days. MD should be kept in mind as one cause of an acute abdomen in preterm neonates mimicking necrotizing enterocolitis. To our knowledge, our patient is the third reported case described in the literature and the first one revealed at birth.

Radiographic diagnosis of meconium peritonitis. A report of 200 cases including six fetal cases.

The radiographic findings of 200 cases of meconium peritonitis were analyzed; 194 cases were discovered in newborn infants and six cases in fetuses. The radiographic features in the newborn group could be categorized as pneumoperitoneum with intestinal obstruction (adhesions) and calcification (35 cases), intestinal obstruction with calcification (143 cases), intestinal obstruction with no radiographically visible calcification (5 cases), and calcification alone (11 cases). All six cases of the fetal group were diagnosed when the mothers had been hospitalized for polyhydramnios and a plaque-like or ring-like calcification showed up in the fetal abdomen on the plain radiograph. Meconium peritonitis is one of the few conditions that can be diagnosed before birth and is almost the only condition around the time of birth to produce calcification in the abdomen. Therefore, if there is any sign of polyhydramnios, radiographs or ultrasonograms of the maternal abdomen should be obtained to detect any calcification within the peritoneal cavity of the fetus. A simple experiment carried out in rats showed that it takes at least eight days after the meconium escapes into the peritoneal cavity for calcification in the meconium to be radiographically demonstrable.

[Pneumoperitoneum in a newborn without intestinal perforation (author's transl)]. / Pneumoperitoneum beim Neugeborenen ohne Perforation des Intestinaltraktes.

This is the report of the rare complication of an isolated pneumoperitoneum in a premature infant of 28 weeks gestation with artificial ventilation due to severe RDS. This rare occurrence in immature babies with artificial ventilation should be considered in the differential diagnosis of abdominal emergencies in this age group. Etiology as well as therapeutic consequences will be discussed.

Gastrointestinal perforation without intraperitoneal air-fluid level in neonatal pneumoperitoneum.

Twenty-one cases of neonatal pneumoperitoneum seen at the C.S. Mott Children's Hospital between 1970 and 1974 were reviewed. Of 14 cases with autopsy or surgically proven gastrointestinal perforation, six did not have an intraperitoneal air-fluid level on the initial cross-table lateral roentgenogram while eight did. Four cases of pneumoperitoneum secondary to mechanically assisted ventilation and air leak phenomenon had no air-fluid level. A postmortem study in one premature infant cadaver suggests that the air-fluid level may not be reliably demonstrated when the amount of intraperitoneal fluid is small. These data support the contention that an intraperitoneal air-fluid level does not uniformly occur in perforated viscus and that its absence, even in the presence of mechanically assisted ventilation, does not exclude the necessity for surgical intervention. In some cases, water-soluble contrast examination of the gastrointestinal tract appears to be a more reliable diagnostic adjunct to document a perforated viscus, when a definite intraperitoneal air-fluid level is not present.