2024 Volume 60 Issue 5 Pages 830-836
In cases of meconium peritonitis, the intra-abdominal situation at the time of surgery varies depending on the timing of gastrointestinal perforation and the extent of inflammatory development, and the surgical method needs to be considered during the operation. Here, we report a case of meconium peritonitis caused by an ileal perforation near the ileocecal valve treated by ileostomy and appendicostomy. A 2,503 g neonate was born by cesarean section at 35 weeks of gestation. Fetal imaging findings suggested meconium peritonitis. Because abdominal distention developed after birth and pneumoperitoneum was observed, urgent surgery was performed on the day of birth. Intraoperative findings showed ileal atresia on the oral side 1.5 cm from the end of the ileum, and an ileal perforation was detected proximally at the atresia site. Meconium leakage from the perforation site was also observed. Most abdominal organs were encased within a large cystic pseudomembranous structure. Inflammation and adhesion in the abdominal cavity were so severe that primary anastomosis seemed difficult; therefore, an ileostomy at the perforation site was constructed. Furthermore, we constructed an appendicostomy for postoperative refeeding enterostomy of the intestinal contents excreted from the proximal ileostomy to the distal bowel. Postoperatively, a good weight gain was achieved by injecting nutritional supplements or intestinal contents into the distal side of the appendicostomy. During stoma closure, the ileum was anastomosed end-to-end. Anastomosis between the ileum of the proximal ileostomy and the ileal atresia site was performed with almost no difference in caliber, and the ileocecal valve was preserved.
