* 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.
Images 1,2: Images show a transverse view of the fetal abdomen, note apparent ascites.