DOI: 10.14260/jemds/2014/3704 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 56/Oct 27, 2014 Page 12834 A RARE CASE OF GIANT MECONIUM PSEUDOCYST: ROLE OF IMAGING Chetana R. Ratnaparkhi 1 , Kajal R. Mitra 2 , Vijaya R. Kamble 3 HOW TO CITE THIS ARTICLE: Chethana R. Ratnaparkhi, Kajal R. Mitra, Vijaya R. Kamble. “A Rare Case of Giant Meconium Pseudocyst: Role of Imaging”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 56, October 27; Page: 12834-12838, DOI: 10.14260/jemds/2014/3704 ABSTRACT: BACKGROUND: Meconium peritonitis with pseudocyst formation is a rare condition associated with significant fetal mortality and morbidity. Meconium peritonitis is a chemical peritonitis resulting from passage of meconium into the peritoneal cavity due to intestinal perforation. Mostly it is due to small bowel perforation resulting from underlying bowel pathologies which includes ischemia or obstruction. Diagnosis of this condition on antenatal ultrasound is possible which guide to the outcome and management in the postnatal life. Computed tomography plays an important role in establishing the diagnosis of meconium pseudocyst and also demonstrate the probable communication of the cyst with bowel. AIM: To assess the role of imaging in diagnosis of meconium pseudocyst with short review of literature. MATERIAL AND METHOD: Both antenatal and postnatal ultrasound of the abdomen along with the computed tomography was done in newborn preterm female fetus. RESULT: A giant meconium pseudocyst is seen secondary to meconium peritonitis in a newborn preterm female child with classical imaging features. On open laparotomy, a huge meconium pseudocyst was excised with jejunum as entry point and terminal ileum as exit point and jejuno-ascending colon anastomosis was done. CONCLUSION: To the best of our knowledge, such a huge size of meconium pseudocyst was not reported in the literature. KEYWORDS: Meconium peritonitis, Meconium Pseudocyst, Ultrasound, Computed Tomography. INTRODUCTION: Meconium peritonitis is an aseptic peritonitis caused by rupture of gastrointestinal tract in utero. Perforation is often secondary to the ischemia or obstruction. (1) Meconium peritonitis is a chemical peritonitis to which body tries to wall off the inflammation which sometimes results in pseudocyst formation and dystrophic calcification. Depending on the cause of perforation, peritonitis may resolve in utero or persist in the postnatal life. Abdominal distension, failure to pass meconium, respiratory distress due to pressure effect on diaphragm and symptoms from the peritonitis are the presenting features. (2) Imaging plays crucial role in diagnosing this condition both in utero and after birth. On radiograph, typical egg shell calcification is hallmark of the pseudocyst. (3) USG along with CT shows characteristics features and plays an important role in diagnosing the cyst. Most of the imaging features are well demonstrated in our case. CASE REPORT: A newborn preterm female (delivered at the gestational age of 33 weeks) weighing 2.7kg was referred to the department of Radio-diagnosis for ultrasound of the abdomen. Baby did not cry immediately after birth and had respiratory distress. On antenatal ultrasound scan done at 32weeks of gestation, a large unilocular intra-abdominal cystic lesion was seen in the fetus with mild polyhydramnios (Fig. 1). Mother had pregnancy induced hypertension during the pregnancy. Baby was delivered at 33weeks of gestation by lower segment cesarean section.