Management of meconium ileus with perforation and formation of a huge pseudocyst: a neonatal case report

Background: Meconium ileus complicated by prenatal perforation and pseudocyst formation is a severe variant requiring prompt surgical management. Case presentation: A female newborn presented with severe abdominal distention, with a prenatal ultrasound showing ascites. Postnatal imaging suggested complex meconium ileus with meconium peritonitis. Laparotomy on day 2 revealed a large pseudocyst and a single perforation. The cyst was drained, adhesions released, inspissated meconium evacuated via appendiceal catheterization, and the perforation repaired. The infant recovered well, tolerated feeds, and was discharged in stable condition. Given family history, evaluation for cystic fibrosis was initiated, and enzyme/vitamin therapy started. Conclusion: Early recognition, timely surgery, and coordinated postoperative care can achieve favorable outcomes even in complex meconium ileus with prenatal perforation and pseudocyst formation. Prenatal identification of abdominal abnormalities should prompt delivery in a center with neonatal surgical capability.