Calcification of the meconium within the bowel of the newborn.

Since Neuhauser (I1944) drew attention to the radiological features of intra-abdominal calcification associated with meconium peritonitis, this condition has been diagnosed with increasing frequency. However, all cases showing intra-abdominal calcification at birth are not due to meconium peritonitis. Up to the present time four cases have been reported which show calcification within the lumen of the bowel. In all except one, some biochemical investigations were carried out. Camp and Roberts (1949) reported a baby with ileal stenosis, in whom calcification was present as small concretions in the meconium. No biochemical studies were done on either the baby or the meconium, but radiographs of the skeleton were normal. Kasmersky and Howard (I1952) described a newborn baby with multiple atresias of the jejunum and calcification of the meconium in the bowel between the atretic segments. It was not stated whether meconium was present distal to the last atretic segment or whether each portion of bowel between the atretic segments contained calcified material. Khilnani, Wolf and Arnheim (1955) reported a case of 'enterolithiasis' in a newborn baby. The pathological features were an imperforate anus, an ectopic right kidney, a deformed right ear, congenital abnormalities of the 11th and 12th dorsal vertebrae and calcification of meconium in the lumen of the bowel. Blood calcium estimations on mother and child were normal; the meconium was not analysed. Rickham (1957) investigated a case of a baby, one month premature, shown radiologically to have calcified intra-abdominal shadows and small gut obstruction. Laparotomy revealed a segment of ileum in which bowel contents were arrested, but no organic obstruction was found. The meconium was washed out and an enterostomy performed. Radiographs of the meconium showed it to be calcified. The condition recurred, and a second operation was necessary, when the proximal intestine was found to be occluded by thick material, and this again proved to be calcified. The baby died, and a hydronephrotic left kidney was found at autopsy. Although trypsin was absent from the first specimen of meconium, trypsin was thereafter present in the duodenal juice and ileal contents. The pancreas was histologically normal, and the baby and mother had normal serum levels of calcium, phosphorus and alkaline phosphatase. Analysis of the meconium showed the phosphorus and calcium to be eight times and five times respectively the normal values given by the author. In the present report, two additional cases of intraluminal intestinal calcification in the newborn are described.