Chemical peritonitis due to intrauterine bowel perforation

Intraperitoneal calcifications in 85%

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  May be only finding if early perforation has healed

Implants on peritoneal surfaces

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  Best seen along liver capsule

  
  
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  May also be in scrotum (meconium periorchitis)

Ascites secondary to both spilled contents and inflammatory response

Meconium pseudocyst results from walled-off perforation

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  Irregular, often angular, thick walls

Dilated bowel seen when meconium peritonitis is secondary to obstruction

Bowel anomalies at risk for perforation: Atresias (distal at greater risk than proximal), meconium ileus, volvulus

Bowel may not be dilated when perforation is secondary to ischemia

Genetic counseling for cystic fibrosis

Spontaneous in utero closure of perforation may occur with no long-term sequelae

Examine liver carefully

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  Calcifications are on capsular surface with meconium peritonitis, while infection causes intraparenchymal calcifications

Try to determine cause of perforation

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  Dilated bowel makes primary intestinal abnormality most likely; look for bowel peristalsis

  
  
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  Nonperistalsing, dilated loops concerning for volvulus with ischemia; ischemic bowel then perforates

Frequent follow-up scans after initial diagnosis

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  May worsen with increasing bowel dilation and abdominal distention

  
  
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  May resolve completely with no sequelae