Abubakar A M, Odelola M A, Bode C O, Sowande A O, Bello M A, Chinda J Y, Jalo I
Paediatric Surgery Unit, Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.
Ann Afr Med. 2008 Dec;7(4):187-91. doi: 10.4103/1596-3519.55655.
Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter.
This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria.
There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X-rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%).
Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.
胎粪性腹膜炎是一种罕见疾病，预后不良。在尼日利亚和非洲，关于该主题仅有零星的病例报告。
这是一项对在迈杜古里大学教学医院（位于博尔诺州迈杜古里）、拉各斯大学教学医院（位于拉各斯州）、奥巴费米·阿沃洛沃大学教学医院联合体（位于奥孙州伊莱-伊费）以及尼日利亚贡贝州联邦医疗中心接受治疗的所有胎粪性腹膜炎患者进行的为期10年的回顾性研究。
共有10名新生儿，其中6名女孩，4名男孩。就诊时的中位年龄为4天（范围2 - 6天）。胎粪性腹膜炎患儿的母亲中，6人接受了产前监护，4人进行了产前超声检查，但均漏诊了胎粪性腹膜炎。最常见的临床表现是10例患者中有9例在出生时出现腹胀。腹部X线检查显示4例患者有钙化和均匀性不透光区，2例患者有气腹。剖腹探查时，所有患者均有炎性粘连带和肠袢缠结。观察到最常见的类型是全身性（7例患者），2例患者有巨大假性囊肿。穿孔最常见的部位是4例患者在回肠，3例患者在空肠。1例患者在剖腹探查时穿孔已封闭。肠梗阻是10例患者中7例胎粪性腹膜炎的最常见原因。其余3例患者病因不明。最常进行的手术是切除吻合术（4例患者）。死亡率很高（50%）。
我们的数据显示胎粪性腹膜炎罕见，肠梗阻是最常见原因。建议对病因不明的患者进行直肠活检以排除先天性巨结肠病。早期诊断、恰当的手术操作和精心的术后护理应能提高其生存率。
