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Published on: October 29, 2014
Meconium ileus--is a single surgical procedure adequate?
1Department of Pediatric Surgery, Dana Children's Hospital, Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. hnagar@@post.tau.ac.il
Insights
Meconium ileus, a cystic fibrosis complication, requires surgery when conservative treatments fail. A single enterotomy, irrigation, and closure procedure effectively resolved obstruction in newborns, avoiding repeat surgeries.
Area of Science:
- Pediatric Surgery
- Neonatology
- Medical Genetics
Background:
- Meconium ileus is a significant gastrointestinal complication in 15% of neonates with cystic fibrosis (CF).
- It arises from the obstruction of the small intestine by inspissated meconium.
- Both nonoperative and operative strategies exist for managing meconium ileus.
Purpose of the Study:
- To evaluate the efficacy of a single surgical intervention for uncomplicated meconium ileus.
- To determine the preferred surgical approach for neonates with meconium ileus unresponsive to conservative management.
- To assess the long-term outcomes of surgical management in CF patients.
Main Methods:
- Retrospective review of five newborns with uncomplicated meconium ileus treated between 1991 and 2003.
- All patients underwent laparotomy, enterotomy, appendectomy, irrigation, and primary closure of the enterotomy.
- Genetic testing confirmed cystic fibrosis in all patients and carrier status in their parents.
Main Results:
- Conservative management failed in all five neonates, necessitating surgical intervention.
- A single surgical procedure (enterotomy, irrigation, and closure) was sufficient for all patients.
- No patient required a second surgical intervention.
- Cystic fibrosis was confirmed in all cases, with both parents being carriers.
Conclusions:
- Enterotomy with irrigation and primary closure is an effective surgical treatment for uncomplicated meconium ileus.
- A single surgical intervention is recommended for meconium ileus in CF patients due to the high risk of pulmonary complications.
- Early surgical intervention with this approach can prevent the need for further procedures.
Abstract:
Meconium ileus is one of the gastrointestinal manifestations of cystic fibrosis (CF), and affects 15% of neonates. The condition results from the accumulation of sticky inspissated meconium. Both nonoperative and operative therapies may be effective in relieving obstruction. The treatment of choice for uncomplicated meconium ileus is the use of enteral N-acetylcysteine or Gastrografin enemata. Once such therapy fails, surgery is indicated. A number of operative procedures are in use, including Bishop-Koop enterostomy, T-tube irrigation, resection and primary anastomosis, and enterotomy with irrigation and primary closure. During the period 1991-2003, five newborns required surgical intervention for uncomplicated meconium ileus. None responded to conservative management. All were males, including one set of twins. All underwent laparotomy, enterotomy, appendectomy, irrigation and closure of enterotomy. None required a second surgical procedure. CF was confirmed in all, and in each case, both parents were found to be genetic carriers of a mutational form of CF. A single surgical intervention is preferable in these patients, in view of the high rate of pulmonary involvement in CF patients. Enterotomy, irrigation and primary closure are the treatment of choice for uncomplicated meconium ileus.
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