Meconium per vaginam secondary to ileal atresia and meconium peritonitis

A neonate was referred for an abdominal mass and passing meconium per vaginam. The anorectum was normal. Roentgenograms revealed a small-bowel obstruction and hypogastric peritoneal calcifications. Findings at celiotomy were: ileal atresia, meconium peritonitis, and two meconium-filled pseudocysts draining through the female genital tract. Excision of the inflammatory masses, resection of the atretic segment, and primary ileoileostomy were followed by an uneventful recovery. Only two similar cases, both fatal, are reported in the English literature. Meconium peritonitis should be considered in the neonate passing meconium per vaginam.