Meckel's diverticulum induced meconium peritonitis in a twin pregnancy

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Title:	Meckel's diverticulum induced meconium peritonitis in a twin pregnancy
Other Titles:	麥克氏憩室導致胎便性腹膜炎
Authors:	黃莉佳(Li-Chia Huang);洪耀欽(Yao-Ching Hung);何銘(Ming Ho)
Contributors:	中國附醫婦產部
Keywords:	高回音腸子;陽套疊;麥克氏憩室;胎便性腹膜炎;雙胞胎;echogenic bowel;intussusception;Meckel's diverticulum;meconium peritonitis;twin pregnancy
Date:	2005-12
Issue Date:	2009-08-20 17:31:54 (UTC+8)
Abstract:	胎便性腹膜炎是一個化學性腹膜炎由於子宮內胎兒腸穿孔所導致，原因包括小腸閉鎖、腸阻塞、腸扭結和腸套疊引起的胎便塞子症候群等。產前診斷是新生兒預後的決定性因素。我們報告一對雙胞胎病例，其中一個胎兒因為麥克氏憩室致胎便性腹膜炎。同時以外科手術方法成功治療。一位30歲經產婦以人工受孕方式懷了三胞胎。在妊娠12週時，孕婦要求進行減胎手術。在懷孕30週時，超音波檢查發現女胎兒有腹水，腹腔內鈣化及腸子擴張的情形。在妊娠38週進行剖腹生產產下一男一女。出生時，女嬰的腹部呈現膨脹，出生後第3天，因疑似腸阻塞，進行手術。手術發現結腸末端有麥克氏憩室合併腸套疊。在發生病變的腸子作切除及端端吻合術，術後情況穩定。胎兒期胎便性腹膜炎可以由超音波作診斷，早期診斷及早治療，對新生兒的預後十分重要。 Meconium peritonitis is a chemical peritonitis resulting from intrauterine bowel perforation. This condition is commonly due to underlying disorders including small bowel atresia, meconium ileus, meconium plug syndrome caused by cystic fibrosis, volvulus, and intussusception. Early prenatal diagnosis can be a decisive factor in prognosis of the neonates. We report a case of fetal meconium peritonitis due to Meckel's diverticulum in a female fetus of a twin pregnancy. The condition was successfully treated surgically. A 30-year-old multipara had been artificially inseminated with her husband's sperm. A triplet pregnancy was achieved and selective fetal reduction was performed at 12 weeks' gestation at the patient's request in our hospital. Ultrasound revealed fetal ascites, intra-abdominal calcification and bowel dilation in the female fetus at 30 weeks' gestation. A normal male infant and a female infant with distended abdomen were delivered by Cesarean section at 38 weeks' gestation. The female infant underwent emergency surgical intervention to treat her progressive abdominal distension. Meckel's diverticulum associated with intussusception and intestinal atresia near the terminal ileum was found. Segmental resection of the pathological intestine followed by end-to-end anastomosis were performed. Post-operative recovery was uneventful. Prenatal diagnosis of meconium peritonitis can be achieved by vigilant ultrasonographic examination. Early diagnosis and early surgical intervention are the decisive factors for good prognosis.
Relation:	Mid-Taiwan Journal of Medicine10(4):218~221
Appears in Collections:	[China Medical University Hospital] Jurnal articles

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