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Open Access Highly Accessed Case report

Giant cystic meconium peritonitis presenting in a neonate with classic radiographic eggshell calcifications and treated with an elective surgical approach: a case report

Erik R Barthel1, Allison L Speer1, Daniel E Levin1, Bindi J Naik-Mathuria2 and Tracy C Grikscheit1*

Author Affiliations

1 Children’s Hospital Los Angeles Division of Pediatric Surgery, 4650 Sunset Boulevard Mailstop 35, Los Angeles, CA 90027, USA

2 Pediatric Surgery, Texas Children’s Clinical Care Center, 6701 Fannin Street, 8th Floor, Houston, TX 77030, USA

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Journal of Medical Case Reports 2012, 6:229  doi:10.1186/1752-1947-6-229

Published: 2 August 2012

Abstract

Introduction

Giant cystic meconium peritonitis is relatively rare. Patients often present with nonspecific physical findings such as distension and emesis. Plain abdominal films remain invaluable for identifying the characteristic calcifications seen with a meconium pseudocyst, and large eggshell calcifications are pathognomonic for the giant cystic subtype.

Case presentation

We present classic plain X-ray findings and an intraoperative image of a premature low birth weight two-day-old Hispanic male baby treated for giant cystic meconium peritonitis with a staged procedure involving peritoneal drainage, ostomy creation and closure.

Conclusion

Pediatric surgeons have a range of potential therapeutic approaches for giant cystic meconium peritonitis. A delay of definitive surgical management in the setting of massive abdominal soiling is a safe and acceptable strategy if adequate temporizing drainage is performed in the early perinatal period.