Eckoldt F, Heling K S, Woderich R, Kraft S, Bollmann R, Mau H
Klinik und Poliklinik für Kinderchirurgie, Universitätsfrauenklinik der Medizinischen Fakultät (Charité), Humboldt-Universität zu Berlin, Germany.
Prenat Diagn. 2003 Nov;23(11):904-8. doi: 10.1002/pd.720.
Intra-uterine bowel perforation can occur secondary to a variety of abnormalities and cause sterile peritonitis in the fetus (generalised = type I). If sealing of the perforation does not take place, a thick-walled pseudo-cyst can form (type II).
Over a 12-year period, 21 616 pregnancies were screened for gastro-intestinal malformations using prenatal ultrasound. We identified 1077 cases suspicious of surgically correctable malformations. Post-natal diagnoses and outcome were worked up retrospectively.
We found 96 fetuses with suspected gastro-intestinal malformations. Prenatal bowel perforation with meconium peritonitis was confirmed in 11 cases. In 5 of these 11, the correct diagnosis had been predicted prenatally. One child presented as a fetal and neonatal emergency (case report). Ten of the eleven infants were operated on during their first day of life. Intra-operative findings were atresia (n = 4), meconium ileus (n = 6) and no obvious cause (n = 1). Two children suffered fatal complications.
Meconium peritonitis and meconium pseudo-cysts as its special manifestation are assessable by prenatal diagnosis but present in different ways. They can present as fetal ascites or echogenic bowel and cause fetal or neonatal distress, requiring close observation and highly specialised care.
子宫内肠穿孔可继发于多种异常情况，并导致胎儿无菌性腹膜炎（全身性=I型）。如果穿孔未封闭，可形成厚壁假性囊肿（II型）。
在12年期间，使用产前超声对21616例妊娠进行胃肠道畸形筛查。我们确定了1077例怀疑可手术矫正畸形的病例。对产后诊断和结局进行回顾性分析。
我们发现96例胎儿怀疑有胃肠道畸形。11例确诊为产前肠穿孔合并胎粪性腹膜炎。在这11例中的5例中，产前已预测出正确诊断。1例患儿表现为胎儿及新生儿急症（病例报告）。11例婴儿中有10例在出生第一天接受了手术。术中发现闭锁（n=4）、胎粪性肠梗阻（n=6），原因不明（n=1）。2例患儿出现致命并发症。
胎粪性腹膜炎及其特殊表现形式胎粪假性囊肿可通过产前诊断进行评估，但表现形式不同。它们可表现为胎儿腹水或肠回声增强，并导致胎儿或新生儿窘迫，需要密切观察和高度专业化的护理。
