“Growing” meconium cyst in one of a discordant twin: a case report

INTRODUCTION: Giant meconium cyst resulting from antenatal bowel perforation is rare and hardly reported in multiple gestations. We found only four documented cases in the electronic literature. CASE PRESENTATION: We report a giant meconium cyst in an 11-hour-old Nigerian boy of a discordant twin having ultrasonographic and plain radiographic diagnosis and surgical confirmation. Increasing abdominal girth from 35 cm to 41 cm within four hours of admission without ascites, pneumoperitneum and significant bowel distension make us assumed the meconium cyst to be “growing” in size. We reviewed the literature and proposed that where the fibrinous wall of meconium cyst allows for distensibility and the communication between the perforated bowel and meconium cyst persists, the meconium cyst acting as reservoir may continue to “grow” in size without remarkable intestinal distension probably, until the elastic limit is lost. CONCLUSION: Meconium cyst can occur in twin pregnancy, grow to occupy the abdomen almost completely and may cause neonatal apnoea. The outcome is good post surgery.