Meconium Peritonitis With Multiple Distal Ileal Perforations, Meconium Pseudocyst, and Extensive Adhesions in A Low-Birth-Weight Neonate: A Case Report and Literature Review

Abstract

Meconium peritonitis is a rare, life-threatening sterile chemical peritonitis resulting from antenatal gastrointestinal perforation. Despite significant advances in prenatal imaging and neonatal surgery, complex presentations continue to carry considerable morbidity and mortality risks. We report the case of a male neonate delivered at 37 weeks of gestation with low birth weight, who presented with progressive abdominal distension immediately after birth, respiratory distress, and failure to pass meconium. Urgent exploratory laparotomy revealed a giant meconium pseudocyst, extensive intra-abdominal adhesions, multiple distal small-bowel perforations, and secondary ischemic necrosis of the transverse colon. Surgical management entailed multiple segmental bowel resections, primary anastomoses, and a double-barrel ileostomy. The patient’s critical postoperative recovery was supported by total parenteral nutrition, broad-spectrum antibiotics, and specialized intensive neonatal care. This case illustrates the complex diagnostic and therapeutic challenges of advanced meconium peritonitis, underscoring that early recognition, timely surgical intervention, and cohesive multidisciplinary collaboration remain paramount for optimal survival.