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Critical Care239 papers

Meconium peritonitis

Last edited: 4/14/2026

Overview

Meconium peritonitis results from intestinal perforation during fetal development, leading to chemical peritonitis due to meconium leakage into the peritoneal cavity, often presenting in neonates with abdominal distension and ascites 545.

Diagnosis

  • Clinical Presentation: Abdominal distension, ascites, and often a palpable mass 545.
  • Imaging: Ultrasound or CT scan may reveal ascites, calcifications (meconium pseudocysts), and bowel obstruction 545.
  • Laboratory Tests: Elevated inflammatory markers, though specific tests are limited 14.
  • Peritoneal Fluid Analysis: Not typically performed due to neonatal considerations; imaging and clinical signs are primary 545.

    • Management

  • Surgical Intervention: Early surgical exploration to address perforation site and manage complications like bowel obstruction 545.
  • Antibiotics: Broad-spectrum antibiotics to cover potential secondary infections, tailored based on culture results 14.
  • Supportive Care: Fluid management, nutritional support, and monitoring for organ dysfunction 14.
  • Source Control: Ensuring complete removal of meconium and infected material to prevent recurrent sepsis 16.

    • Special Populations

  • Neonates: Primary focus due to prenatal origin; management centered around neonatal surgical capabilities and supportive care 545.

    • Key Recommendations

  • Early Surgical Exploration: Essential for neonates with suspected meconium peritonitis to address underlying perforation and prevent complications 545 (Evidence: Strong).
  • Broad-Spectrum Antibiotics: Initiate empirical broad-spectrum antibiotics preoperatively and adjust based on culture results 14 (Evidence: Moderate).
  • Supportive Measures: Implement comprehensive supportive care including fluid and nutritional support to manage systemic effects 14 (Evidence: Moderate).

    • References

    1 Rasslan R, de Oliveira Ferreira F, Parra JAP, da Costa Ferreira Novo F, Menegozzo CAM, Alves PHF et al.. Damage control surgery in non-traumatic abdominal emergencies: prognostic value of SOFA, APACHEII, and Mannheim peritonitis index. Updates in surgery 2025. link 2 Olausson M, Tolver MA, Gögenur I. High risk of short-term mortality and postoperative complications in patients with generalized peritonitis undergoing major emergency abdominal surgery-a cohort study. Langenbeck's archives of surgery 2025. link 3 Prince LK, Y'Barbo BC, Nee R, Yuan CM. The peritoneal dialysis orders objective structured clinical examination (OSCE): A formative assessment for nephrology fellows. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 2021. link 4 Fallani G, Lombardi R, Masetti M, Chisari M, Zanini N, Cattaneo GM et al.. Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis. Updates in surgery 2021. link 5 Matsuoka T, Ichihara N, Shinozaki H, Kobayashi K, Lefor AK, Kimura T et al.. Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan. World journal of emergency surgery : WJES 2021. link 6 Ceri M, Mert M, Dursun B. Peritonitis Due to Streptococcus Sanguinis in Automated Peritoneal Dialysis. Iranian journal of kidney diseases 2020. link 7 Al Bshabshe A, Joseph MRP, Battayah ES, Hamid ME. Fungal peritonitis caused by Pichia kudriavzevii following sleeve gastrectomy. Annals of Saudi medicine 2019. link 8 Chestnova TV, Zilov VG, Gladkikh PG, Khadartsev AA, Korotkova AS, Buzulukov YP. Combined Effect of Silver Nanoparticles, Ceftriaxone, and Methyluracil during Experimental Purulent Peritonitis. Bulletin of experimental biology and medicine 2018. link 9 Lee SH, Lee JY, Hong TH, Kim BO, Lee YJ, Lee JG. Severe persistent hypocholesterolemia after emergency gastrointestinal surgery predicts in-hospital mortality in critically ill patients with diffuse peritonitis. PloS one 2018. link 10 Varela ML, Mogildea M, Moreno I, Nunez D. From the Pharynx to the Abdomen: A Case of Primary Peritonitis. Acta medica portuguesa 2018. link 11 Dhruve MJ, Bargman JM. Antibiotic Prophylaxis in Peritoneal Dialysis Patients. Advances in peritoneal dialysis. Conference on Peritoneal Dialysis 2017. link 12 Hof H, Amann V, Tauber C, Paulun A. Peritonitis in a neonate due to Cyberlindnera fabianii, an ascomycetic yeast. Infection 2017. link 13 Tolonen M, Sallinen V, Mentula P, Leppäniemi A. Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study. Langenbeck's archives of surgery 2016. link 14 Kanamori Y, Terawaki K, Takayasu H, Sugiyama M, Komura M, Kodaka T et al.. Interleukin 6 and interleukin 8 play important roles in systemic inflammatory response syndrome of meconium peritonitis. Surgery today 2012. link 15 Atalay H, Güney I, Solak Y, Almaz E. First case of CAPD-related peritonitis caused by Morganella morganii. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 2010. link 16 Horwood J, Akbar F, Maw A. Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. Annals of the Royal College of Surgeons of England 2009. link 17 Pasticci MB, Donnini A, Mencacci A, Lapalorcia LM, Cavazzoni E, Baldelli F. A diagnosis of pneumococcal peritonitis secondary to pyo-salpinx in a young healthy female by culturing peritoneal pus. The new microbiologica 2008. link 18 Weiss G, Meyer F, Lippert H. Infectiological diagnostic problems in tertiary peritonitis. Langenbeck's archives of surgery 2006. link 19 Notash AY, Salimi J, Rahimian H, Fesharaki Ms, Abbasi A. Evaluation of Mannheim peritonitis index and multiple organ failure score in patients with peritonitis. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2005. link 20 Hutchins RR, Gunning MP, Lucas DN, Allen-Mersh TG, Soni NC. Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery. World journal of surgery 2004. link 21 Dupont H, Bourichon A, Paugam-Burtz C, Mantz J, Desmonts JM. Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis?. Critical care medicine 2003. link 22 Conly JM, Vas S. Increasing mupirocin resistance of Staphylococcus aureus in CAPD--should it continue to be used as prophylaxis?. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 2002. link 23 Zügel N, Siebeck M, Geissler B, Lichtwark-Aschoff M, Gippner-Steppert C, Witte J et al.. Circulating mediators and organ function in patients undergoing planned relaparotomy vs conventional surgical therapy in severe secondary peritonitis. Archives of surgery (Chicago, Ill. : 1960) 2002. link 24 Holzheimer RG, Dralle H. Paradigm change in 30 years peritonitis treatment -- a review on source control. European journal of medical research 2001. link 25 Sewnath ME, Olszyna DP, Birjmohun R, ten Kate FJ, Gouma DJ, van Der Poll T. IL-10-deficient mice demonstrate multiple organ failure and increased mortality during Escherichia coli peritonitis despite an accelerated bacterial clearance. Journal of immunology (Baltimore, Md. : 1950) 2001. link 26 Johnson JL, Wallace BH, Mareen CD, Graves DB, Ferrer TJ, Robertson RD et al.. Intraperitoneal blood exacerbates the remote inflammatory response to murine peritonitis. The Journal of trauma 2001. link 27 Gardinali M, Borrelli E, Chiara O, Lundberg C, Padalino P, Conciato L et al.. Inhibition of CD11-CD18 complex prevents acute lung injury and reduces mortality after peritonitis in rabbits. American journal of respiratory and critical care medicine 2000. link 28 Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World journal of surgery 2000. link 29 Betriu C, Coronel F, Martin P, Picazo JJ. Peritonitis caused by Haemophilus parainfluenzae in a patient undergoing continuous ambulatory peritoneal dialysis. Journal of clinical microbiology 1999. link 30 Kikuchi M, Endo S, Inada K, Inoue Y, Wakabayashi G, Ishikura H et al.. Assessment of inflammatory mediators in patients with generalized peritonitis. Journal of medicine 1999. link 31 Wanic-Kossowska M, Grzegorzewska A, Płotast H. Sclerosing encapsulating peritonitis. International urology and nephrology 1998. link 32 Lopes JO, Alves SH, Klock C, Oliveira LT, Dal Forno NR. Trichosporon inkin peritonitis during continuous ambulatory peritoneal dialysis with bibliography review. Mycopathologia 1997. link 33 Wickel DJ, Cheadle WG, Mercer-Jones MA, Garrison RN. Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection. Annals of surgery 1997. link 34 Farber MS, Abrams JH. Antibiotics for the acute abdomen. The Surgical clinics of North America 1997. link70624-1) 35 Reemst PH, van Goor H, Goris RJ. SIRS, MODS and tertiary peritonitis. The European journal of surgery. Supplement. : = Acta chirurgica. Supplement 1996. link 36 Koperna T, Schulz F. Prognosis and treatment of peritonitis. Do we need new scoring systems?. Archives of surgery (Chicago, Ill. : 1960) 1996. link 37 Graham JC, Moss PJ, McKendrick MW. Primary group A streptococcal peritonitis. Scandinavian journal of infectious diseases 1995. link 38 Lopes JO, Alves SH, Benevenga JP, Regio OR, Calil A. Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis. Mycopathologia 1993. link 39 Rosman C, Grond J, Buurman WA, de Smet BJ, de Jonge R, Sietsma M et al.. Fish oil increases the release of tumour necrosis factor and interleukin-6, and has no effect on the incidence of multiple organ failure in rats with peritonitis. The European journal of surgery = Acta chirurgica 1993. link 40 Freiman JP, Graham DJ, Reed TG, McGoodwin EB. Chemical peritonitis following the intraperitoneal administration of vancomycin. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 1992. link 41 Straube E, Ockert G, Koch H, Schneider A, Diener C, Hartmann M. Peritonitis caused by Trichomonas--a preliminary case report. Zentralblatt fur Bakteriologie : international journal of medical microbiology 1991. link80306-3) 42 Berer D, Kitterer WR, Berger HG. Are the serum levels of endotoxin-binding proteins reliable predictors of complications in the course of peritonitis?. European journal of clinical investigation 1990. link 43 Tighe D, Moss R, Boghossian S, Heath MF, Chessum B, Bennett ED. Multi-organ damage resulting from experimental faecal peritonitis. Clinical science (London, England : 1979) 1989. link 44 von Graevenitz A. Is there an optimal methodology for the microbiological analysis of effluent in CAPD peritonitis?. Zentralblatt fur Bakteriologie, Mikrobiologie, und Hygiene. Series A, Medical microbiology, infectious diseases, virology, parasitology 1988. link80049-x) 45 Martin LW, Glen PM. Prenatal appendiceal perforation: a case report. Journal of pediatric surgery 1986. link80661-3) 46 Teichmann W, Wittmann DH, Andreone PA. Scheduled reoperations (etappenlavage) for diffuse peritonitis. Archives of surgery (Chicago, Ill. : 1960) 1986. link 47 Hudson S, Mackie R, Stewart WK. Lock-ring for Tenckhoff catheter/titanium adaptor junction. Uremia investigation 1985. link 48 Wouters DB, Krom RA, Slooff MJ, Kootstra G, Kuijjer PJ. The use of Marlex mesh in patients with generalized peritonitis and multiple organ system failure. Surgery, gynecology & obstetrics 1983. link 49 Pepersack F, D'Haene M, Toussaint C, Schoutens E. Campylobacter jejuni peritonitis complicating continuous ambulatory peritoneal dialysis. Journal of clinical microbiology 1982. link 50 Lahiri VL, Elhence BR, Agarwal BM. Balantidium peritonitis diagnosed on cytologic material. Acta cytologica 1977. link 51 Holliday RL. Peritonitis--old and new thoughts. Heart & lung : the journal of critical care 1975. link

    Original source

    1. [1]
      Damage control surgery in non-traumatic abdominal emergencies: prognostic value of SOFA, APACHEII, and Mannheim peritonitis index. — Rasslan R, de Oliveira Ferreira F, Parra JAP, da Costa Ferreira Novo F, Menegozzo CAM, Alves PHF et al. Updates in surgery (2025)
    2. [2]
      High risk of short-term mortality and postoperative complications in patients with generalized peritonitis undergoing major emergency abdominal surgery-a cohort study. — Olausson M, Tolver MA, Gögenur I Langenbeck's archives of surgery (2025)
    3. [3]
      The peritoneal dialysis orders objective structured clinical examination (OSCE): A formative assessment for nephrology fellows. — Prince LK, Y'Barbo BC, Nee R, Yuan CM Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis (2021)
    4. [4]
      Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis. — Fallani G, Lombardi R, Masetti M, Chisari M, Zanini N, Cattaneo GM et al. Updates in surgery (2021)
    5. [5]
      Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan. — Matsuoka T, Ichihara N, Shinozaki H, Kobayashi K, Lefor AK, Kimura T et al. World journal of emergency surgery : WJES (2021)
    6. [6]
      Peritonitis Due to Streptococcus Sanguinis in Automated Peritoneal Dialysis. — Ceri M, Mert M, Dursun B Iranian journal of kidney diseases (2020)
    7. [7]
      Fungal peritonitis caused by Pichia kudriavzevii following sleeve gastrectomy. — Al Bshabshe A, Joseph MRP, Battayah ES, Hamid ME Annals of Saudi medicine (2019)
    8. [8]
      Combined Effect of Silver Nanoparticles, Ceftriaxone, and Methyluracil during Experimental Purulent Peritonitis. — Chestnova TV, Zilov VG, Gladkikh PG, Khadartsev AA, Korotkova AS, Buzulukov YP Bulletin of experimental biology and medicine (2018)
    9. [9]
      Severe persistent hypocholesterolemia after emergency gastrointestinal surgery predicts in-hospital mortality in critically ill patients with diffuse peritonitis. — Lee SH, Lee JY, Hong TH, Kim BO, Lee YJ, Lee JG PloS one (2018)
    10. [10]
      From the Pharynx to the Abdomen: A Case of Primary Peritonitis. — Varela ML, Mogildea M, Moreno I, Nunez D Acta medica portuguesa (2018)
    11. [11]
      Antibiotic Prophylaxis in Peritoneal Dialysis Patients. — Dhruve MJ, Bargman JM Advances in peritoneal dialysis. Conference on Peritoneal Dialysis (2017)
    12. [12]
      Peritonitis in a neonate due to Cyberlindnera fabianii, an ascomycetic yeast. — Hof H, Amann V, Tauber C, Paulun A Infection (2017)
    13. [13]
      Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study. — Tolonen M, Sallinen V, Mentula P, Leppäniemi A Langenbeck's archives of surgery (2016)
    14. [14]
      Interleukin 6 and interleukin 8 play important roles in systemic inflammatory response syndrome of meconium peritonitis. — Kanamori Y, Terawaki K, Takayasu H, Sugiyama M, Komura M, Kodaka T et al. Surgery today (2012)
    15. [15]
      First case of CAPD-related peritonitis caused by Morganella morganii. — Atalay H, Güney I, Solak Y, Almaz E Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis (2010)
    16. [16]
      Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. — Horwood J, Akbar F, Maw A Annals of the Royal College of Surgeons of England (2009)
    17. [17]
      A diagnosis of pneumococcal peritonitis secondary to pyo-salpinx in a young healthy female by culturing peritoneal pus. — Pasticci MB, Donnini A, Mencacci A, Lapalorcia LM, Cavazzoni E, Baldelli F The new microbiologica (2008)
    18. [18]
      Infectiological diagnostic problems in tertiary peritonitis. — Weiss G, Meyer F, Lippert H Langenbeck's archives of surgery (2006)
    19. [19]
      Evaluation of Mannheim peritonitis index and multiple organ failure score in patients with peritonitis. — Notash AY, Salimi J, Rahimian H, Fesharaki Ms, Abbasi A Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (2005)
    20. [20]
      Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery. — Hutchins RR, Gunning MP, Lucas DN, Allen-Mersh TG, Soni NC World journal of surgery (2004)
    21. [21]
      Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis? — Dupont H, Bourichon A, Paugam-Burtz C, Mantz J, Desmonts JM Critical care medicine (2003)
    22. [22]
      Increasing mupirocin resistance of Staphylococcus aureus in CAPD--should it continue to be used as prophylaxis? — Conly JM, Vas S Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis (2002)
    23. [23]
      Circulating mediators and organ function in patients undergoing planned relaparotomy vs conventional surgical therapy in severe secondary peritonitis. — Zügel N, Siebeck M, Geissler B, Lichtwark-Aschoff M, Gippner-Steppert C, Witte J et al. Archives of surgery (Chicago, Ill. : 1960) (2002)
    24. [24]
      Paradigm change in 30 years peritonitis treatment -- a review on source control. — Holzheimer RG, Dralle H European journal of medical research (2001)
    25. [25]
      IL-10-deficient mice demonstrate multiple organ failure and increased mortality during Escherichia coli peritonitis despite an accelerated bacterial clearance. — Sewnath ME, Olszyna DP, Birjmohun R, ten Kate FJ, Gouma DJ, van Der Poll T Journal of immunology (Baltimore, Md. : 1950) (2001)
    26. [26]
      Intraperitoneal blood exacerbates the remote inflammatory response to murine peritonitis. — Johnson JL, Wallace BH, Mareen CD, Graves DB, Ferrer TJ, Robertson RD et al. The Journal of trauma (2001)
    27. [27]
      Inhibition of CD11-CD18 complex prevents acute lung injury and reduces mortality after peritonitis in rabbits. — Gardinali M, Borrelli E, Chiara O, Lundberg C, Padalino P, Conciato L et al. American journal of respiratory and critical care medicine (2000)
    28. [28]
      Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. — Koperna T, Schulz F World journal of surgery (2000)
    29. [29]
      Peritonitis caused by Haemophilus parainfluenzae in a patient undergoing continuous ambulatory peritoneal dialysis. — Betriu C, Coronel F, Martin P, Picazo JJ Journal of clinical microbiology (1999)
    30. [30]
      Assessment of inflammatory mediators in patients with generalized peritonitis. — Kikuchi M, Endo S, Inada K, Inoue Y, Wakabayashi G, Ishikura H et al. Journal of medicine (1999)
    31. [31]
      Sclerosing encapsulating peritonitis. — Wanic-Kossowska M, Grzegorzewska A, Płotast H International urology and nephrology (1998)
    32. [32]
      Trichosporon inkin peritonitis during continuous ambulatory peritoneal dialysis with bibliography review. — Lopes JO, Alves SH, Klock C, Oliveira LT, Dal Forno NR Mycopathologia (1997)
    33. [33]
      Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection. — Wickel DJ, Cheadle WG, Mercer-Jones MA, Garrison RN Annals of surgery (1997)
    34. [34]
      Antibiotics for the acute abdomen. — Farber MS, Abrams JH The Surgical clinics of North America (1997)
    35. [35]
      SIRS, MODS and tertiary peritonitis. — Reemst PH, van Goor H, Goris RJ The European journal of surgery. Supplement. : = Acta chirurgica. Supplement (1996)
    36. [36]
      Prognosis and treatment of peritonitis. Do we need new scoring systems? — Koperna T, Schulz F Archives of surgery (Chicago, Ill. : 1960) (1996)
    37. [37]
      Primary group A streptococcal peritonitis. — Graham JC, Moss PJ, McKendrick MW Scandinavian journal of infectious diseases (1995)
    38. [38]
      Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis. — Lopes JO, Alves SH, Benevenga JP, Regio OR, Calil A Mycopathologia (1993)
    39. [39]
      Fish oil increases the release of tumour necrosis factor and interleukin-6, and has no effect on the incidence of multiple organ failure in rats with peritonitis. — Rosman C, Grond J, Buurman WA, de Smet BJ, de Jonge R, Sietsma M et al. The European journal of surgery = Acta chirurgica (1993)
    40. [40]
      Chemical peritonitis following the intraperitoneal administration of vancomycin. — Freiman JP, Graham DJ, Reed TG, McGoodwin EB Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis (1992)
    41. [41]
      Peritonitis caused by Trichomonas--a preliminary case report. — Straube E, Ockert G, Koch H, Schneider A, Diener C, Hartmann M Zentralblatt fur Bakteriologie : international journal of medical microbiology (1991)
    42. [42]
      Are the serum levels of endotoxin-binding proteins reliable predictors of complications in the course of peritonitis? — Berer D, Kitterer WR, Berger HG European journal of clinical investigation (1990)
    43. [43]
      Multi-organ damage resulting from experimental faecal peritonitis. — Tighe D, Moss R, Boghossian S, Heath MF, Chessum B, Bennett ED Clinical science (London, England : 1979) (1989)
    44. [44]
      Is there an optimal methodology for the microbiological analysis of effluent in CAPD peritonitis? — von Graevenitz A Zentralblatt fur Bakteriologie, Mikrobiologie, und Hygiene. Series A, Medical microbiology, infectious diseases, virology, parasitology (1988)
    45. [45]
      Prenatal appendiceal perforation: a case report. — Martin LW, Glen PM Journal of pediatric surgery (1986)
    46. [46]
      Scheduled reoperations (etappenlavage) for diffuse peritonitis. — Teichmann W, Wittmann DH, Andreone PA Archives of surgery (Chicago, Ill. : 1960) (1986)
    47. [47]
      Lock-ring for Tenckhoff catheter/titanium adaptor junction. — Hudson S, Mackie R, Stewart WK Uremia investigation (1985)
    48. [48]
      The use of Marlex mesh in patients with generalized peritonitis and multiple organ system failure. — Wouters DB, Krom RA, Slooff MJ, Kootstra G, Kuijjer PJ Surgery, gynecology & obstetrics (1983)
    49. [49]
      Campylobacter jejuni peritonitis complicating continuous ambulatory peritoneal dialysis. — Pepersack F, D'Haene M, Toussaint C, Schoutens E Journal of clinical microbiology (1982)
    50. [50]
      Balantidium peritonitis diagnosed on cytologic material. — Lahiri VL, Elhence BR, Agarwal BM Acta cytologica (1977)
    51. [51]
      Peritonitis--old and new thoughts. — Holliday RL Heart & lung : the journal of critical care (1975)
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