ABOELLAIL Mohamed¹, 田中 宏和¹, 森 信博¹, 田中 彩², 久保 裕之², 下野 隆一², 秦 利之¹

Mohamed ABOELLAIL¹, Hirokazu TANAKA¹, Nobuhiro MORI¹, Aya TANAKA², Hiroyuki KUBO², Ryuichi SHIMONO², Toshiyuki HATA¹

¹Kagawa University Graduate School of MedicineDepartment of Perinatology and Gynecology, ²Department of Pediatric Surgery, Kagawa University Graduate School of Medicine

¹Department of Perinatology and Gynecology, Kagawa University School of Medicine, ²Department of Pediatric Surgery, Kagawa University Graduate School of Medicine

キーワード :

［Introduction］
Meconium peritonitis（MP）is sterile chemical peritonitis due to fetal intestinal perforation in utero［1］．Its incidence is approximately 1/35,000 live births［2］．2D sonographic findings include polyhydramnios, bowel dilatation, abdominal calcification or an echogenic mass, and fetal ascites［3］；however, these features are variable and not specific to MP［2］．We present first experience of HDlive features of fetal meconium peritonitis.
［Case report］
A 33-year-old pregnant Japanese woman, gravida 1，para 0，was referred to our ultrasound clinic at 32 weeks and 2 days of gestation because of suspected polyhydramnios and fetal bowel dilatation. 2D sonography showed multiple cystic intestinal dilatations（maximum caliber diameter: 25.8 mm）with thickened intestinal wall, and calcifications in the fetal abdominal cavity. HDlive revealed irregularly thickened wall of these dilated loops, and presence of fine, granular meconium inside them. HDlive inversion mode clearly showed these cystic dilatations of the intestine continuous with each other, confirming diagnosis as the small intestinal dilatation. Dilatation site was accurately localized, and the dilated loops showed irregular caliber changes. These findings seem to be consistent with meconium peritonitis（MP）. Two weeks later, emergency caesarian section was performed due to premature membrane rupture with breech presentation, and plain X-ray on day 1 revealed abdominal calcification, confirming the diagnosis of MP.
［Discussion］
HDlive and HDlive inversion mode clearly showed the irregularly thickened wall of dilated intestinal loops with irregular calibers and the presence of meconium inside them confirming diagnosis of MP. Moreover, etiology was identified because these changes are caused by meconium ileus, which is different from ileal atresia with the uniform, regular caliber. The new realistic images of the intestinal inner wall, its thickness, and contents obtained by HDlive resemble those obtained by endoscopy. Therefore, HDlive can be considered as virtual endoscopy showing an endoscopic-like realistic image non-invasively, and was much easier and more feasible compared to CT or MRI. In conclusion, we recommend the use of HDlive in the prenatal diagnosis of MP as an adjunct tool with potential advantages compared to the use of conventional 2D sonography alone.
［Refrences］
1.Dirkes K, Crombleholme TM, Craigo SD, Latchaw LA, Jacir NN, Harris BH, D’Alton ME. The natural history of meconium peritonitis diagnosed in utero. J Pediatr Surg 1995; 30:979-982.
2.Foster M, Nyberg D, Mahony B, Mack L, Marks W, Raabe R. Meconium peritonitis: prenatal sonographic findings and their clinical significance. Radiology 1987; 165:661-665.
3.Wang C-N, Chang S-D, Chao A-S, Wang T-H, Tseng L-H, Chang Y-L. Meconium Peritonitis In Utero-the Value of Prenatal Diagnosis in Determining Neonatal Outcome. Taiwan J Obstet Gynecol 2008，47:391-396.