Cases of meconium peritonitis have been divided into 2 groups, of roughly equal incidence, depending on the presence or absence of intestinal obstruction,1,2 although the actual cause of the intestinal perforation often remains uncertain. Where there is intestinal obstruction it might be argued that increased peristalsis leads to the perforation, especially if part of the gut is distended and its wall is thin and ischemic. Where no obstruction can be found it is tempting to assume some local abnormality weakens the gut so that normal peristaltic movements are sufficient to rupture it.
Numerous causes of spontaneous perforation have been cited, such as muscle aplasia,1 hyperplasia of lymphoid tissue and abnormally deep crypts of Lieberkühn's glands,2 abnormally wide gaps accompanying the vessels penetrating the muscle layers,3 angiomatous-like malformations,4 and ulceration by meconium plugs.5 The difficulties in establishing the cause of perforation in any given case
ANDERSON GS. Spontaneous Perforation of the Fetal Colon. Am J Dis Child. 1962;103(2):166-168. doi:10.1001/archpedi.1962.02080020172010