PERINATOLOGY • Vol 24 • No. 1 • May–Aug 2023 • 69 Alvarez Saenz MP, et al. Meconium Peritonitis Case Report eliminate both the proximal and distal small intestine and the distal colon. The end-to-end anastomosis of the jejunum and the ileum was performed. The fragments of the first resection and the 2 mouths of the ostomies were sent for pathologic examination. The pathology report described a serosa with a dark brown congestive appearance covered by greenish material and purulent membranes. An erosive and hemorrhagic mucosa was also observed. Mural and transmural necrosis, with extensive hemorrhage, and inflammatory infiltrate of polymorphonuclear cells with fibrin deposits were observed (Figure 3). With these features, the condition was diagnosed as meconium peritonitis. In the immediate postoperative period, an abdominal X-ray was taken, which showed the irrigated contrast during the surgical procedure, indicating a disuse microcolon (Figure 4A). In the mediate postoperative period, the neonate presented persistent abdominal distension. To address this, an intestinal transit was performed, which showed an intestinal obstruction (Figure 4B). Pediatric surgeons considered the obstruction secondary to impaction due to meconium ileus, which did not resolve despite the administration of intraoperative and postoperative water-soluble contrast. Hence, the pediatric surgeon suggested to manage this condition with mineral oil enemas, achieving resolution of the meconium ileus. Currently, the neonate is 5 months old and is tolerating the total enteral route by suction well, with good gain in weight and height. The neonate does not have abdominal distension and emetic episodes and has spontaneous stools. Genetic analysis showed homozygous positive mutation at c.3484C> T (R1162X), confirming CF. The interdisciplinary management by pediatric gastroenterologists, pneumologists, and pediatric surgeons continues. Figure 2. (A) Dilated Intestinal Loop With Hypaque (Distal Atresia Ruled Out); (B) Second Surgery That Identified Adherent Meconium as Asphalt Figure 3. (A) The Shortening of Villi Suggests Chronicity of the Ischemic Process; (B) The Presence of Corneal Flakes Indicates the Presence of Meconial Material in Serosa Partially viable own muscle (outer layer) Serosa with fibrin and bleeding Viable mucosa and submucosa Own viable muscle Corneal scales Serosa with fibrin Necrotic submucous Muscular necrotic mucous Necrotic mucosa with shortened villi Figure 4. (A) Immediate Postoperative Radiography After the Second Surgery With the Evidence of Hypaque Hyperosmolar Solution Acting as a Contrast Agent Showing Microcolon; (B) Late Postoperative Radiography Showing Intestinal Obstruction A B A B A B
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