Chapter 70
##### KEY POINTS

Key Points

• Causes of intra-abdominal calcification include meconium peritonitis, enterolithiasis, cholelithiasis, and fetus in fetu.

• Meconium peritonitis is the most common cause of intra-abdominal calcifications.

• Cystic fibrosis is seen in only 8% to 13.5% of cases of fetal meconium peritonitis in contrast to 15% to 40% postnatally.

• Enterolithiasis is often associated with rectourinary fistula as in imperforate anus or cloaca.

• Enterolithiasis can be seen in bowel obstruction such as jejunoileal atresia or total colonic Hirschsprung’s disease.

• Fetus in fetu is distinguished by the presence of well-formed long bones or vertebral bodies.

##### CONDITION

The most common causes of intra-abdominal calcifications include hepatic calcifications, meconium peritonitis, enterolithiasis, cholelithiasis, and fetus in fetu. The topic of hepatic calcification is fully covered in Chapter 69 and will not be covered further except to indicate how these can be distinguished from other causes of intra-abdominal calcifications.

Perforation of the bowel that occurs antenatally leads to a sterile chemical peritonitis referred to as meconium peritonitis, which is the most common cause of intra-abdominal calcifications. The peritonitis can be localized or diffuse and can lead to a fibrotic reaction with intraperitoneal calcifications. The clinical manifestations of meconium peritonitis depend on its underlying cause, timing, and whether or not the perforation heals spontaneously. The spectrum of disease ranges from asymptomatic intra-abdominal calcifications to giant cystic meconium peritonitis (Robertson et al., 1994; Dirkes et al., 1995; Kamata et al., 2000; Tseng et al., 2003; Zangheri et al., 2007). Meconium peritonitis has been associated with intestinal atresia or stenosis, meconium ileus, internal hernia, bowel ileus, intussusception, gastroschisis, Meckel diverticulum, and cytomegalovirus infection (Pletcher et al., 1991; Petrikovsky et al., 1993).

The presence of associated anomalies is unusual and depends on the underlying cause of meconium peritonitis. Up to 15% to 40% of neonates with meconium peritonitis have cystic fibrosis (Park and Grand, 1981; Payne and Nielsen, 1983). However, in prenatally diagnosed meconium peritonitis, cystic fibrosis is reported to be the cause in only 8% to 13.5% of cases (Foster et al., 1987; Dirkes et al., 1995; Casaccia et al., 2003). This apparent discrepancy may be due to the increased sensitivity of prenatal sonographic imaging in detecting abdominal calcification, as compared with postnatal plain films (Williams et al., 1984). It has also been suggested that sonographically detected calcifications could be due to fetal viral infection due to parvovirus B19, cytomegalovirus, herpes viruses, or even taxoplasmosis (Casaccia et al., 2003). It is also possible that cystic fibrosis is less likely to cause calcification due to the deficiency of pancreatic enzymes (Foster et al., 1987). The incidence of cystic fibrosis increases if there are other additional sonographic findings such as dilated bowel and hyperechoic bowel. The presence of calcifications alone suggests the risk of cystic fibrosis of 13% and ...

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