Arun K. Nair

Meconium peritonitis secondary to torsion of fallopian tube cyst and transient central diabetes insipidus in a preterm infant

Abstract Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.

A coiled nasogastric tube in a newborn

Sir, Antenatal ultrasonography at 32 weeks gestation of a 40-year-old mother revealed polyhydramnios with absence of the gastric bubble. A term female infant weighing 3290 g was born by vacuum extraction. She had Down’s syndrome and was noticed to have mild frothing from mouth. A nasogastric tube inserted was seen coiled in the esophagus with presence of air in the stomach (Figure 1). She was referred to us as esophageal atresia with distal tracheoesophageal fistula. On reviewing the plain radiograph of the chest and abdomen, the 6 French (F) nasogastric tube was found to be coiled in the esophagus at the 9th thoracic vertebral level. Since the level of the coiled tube was below the carina (4th thoracic) it was removed. A radiograph taken after insertion of a stiff 8 F nasogastric tube ruled out esophageal atresia (Figure 2). Esophageal atresia is a common congenital disorder diagnosed in the fetus by absence of the stomach bubble on a prenatal ultrasonogram in a mother with polyhydramnios w2x. At birth the neonate presents with frothing, coughing, choking and cyanosis on feeding. If esophageal atresia is suspected and a thin flexible nasogastric tube inserted, it may curl in the upper pouch of the atresia giving a false impression that it has passed into the stomach. A thin tube may also get coiled in a normal esophagus, as in this patient. While passing a stiff bigger tube, care should be taken not to perforate a normal esophagus thereby simulating esophageal atresia w1x. Undue pressure by a stiff tube can also perforate the upper pouch of an esophageal atresia mimicking absence of it. In all cases of suspected esophageal atresia, a plain radiograph of the chest and abdomen must be obtained to confirm the position of the tube and presence of air in the stomach and distally.