Meconium peritonitis is a primarily aseptic, chemical peritonitis caused by the spill of meconium into the abdominal cavity through an intestinal perforation during the intrauterine or perinatal period. The perforation is known to be related to intrauterine vascular compromise. Recently, the authors experienced 4 cases of ileal atresia complicated by meconium peritonitis. The male to female sex ratio was 1 : 3, and age at operation was 1 day(2 cases), 3 days(2 cases). Three cases had generalized peritonitis, and one the cystic type of meconium peritonitis. The types of ileal atresia were IIIa(2 cases), IIIb(1 case), and II(1 case). The proximal blind ileal end was perforated in 3 cases, and distal end perforation was in 1 case of cystic type. Postoperative recovery was excellent in all cases.

A 2-day-old male {Premie, Large for gestational age(LGA), Intrauterine period (IUP) 33 weeks, birth weight 2,955 gram} was transferred with marked abdominal distention, bilious return via the orogastric tube, respiratory difficulty, and generalized edema (hydrops fetalis). He was born by cesarean section to a 36 year-old mother. Antenatal ultrasonogram at IUP 31 weeks demonstrated multiple dilated bowel loops suggestive of intestinal obstruction. There was no family history of cystic fibrosis. Simple abdominal films disclosed diffuse haziness and suspicious fine calcifications in the right lower quadrant. Barium enema demonstrated a microcolon. Sweat chloride test was not available in our institution. At laparotomy, there noted 1) a segmental volvulus of the small bowel with gangrenous change, associated with meconium peritonitis, 2) an atresia of the ileum at the base of the volvulus, and 3) the terminal ileum distal to the volvulus was narrow and impacted with rabbit pellets-like thick meconium. These findings appeared to be very similar to those of a complicated meconium ileus. In . summary, the ileal atresia and meconium peritonitis seemed to be caused by antenatal segmental volvulus of the small intestine in a patient with probable meconeum ileus.