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Changing patterns of treatment and survival in neonates with meconium ileus
F J Rescorla1, J L Grosfeld, K J West
1Department of Surgery, Indiana University School of Medicine, Indianapolis.
Insights
Meconium ileus in neonates can be treated nonoperatively with Gastrografin enema or enterotomy irrigation, improving survival rates. This approach avoids surgery in many uncomplicated cases, enhancing outcomes for newborns.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastroenterology
Background:
- Meconium ileus is a common neonatal surgical emergency.
- Historically, surgical intervention was the primary treatment.
- Improved diagnostic and therapeutic strategies are needed.
Purpose of the Study:
- To analyze treatment patterns and outcomes for neonates with meconium ileus.
- To evaluate the efficacy of nonoperative management.
- To assess survival rates in uncomplicated and complicated meconium ileus.
Main Methods:
- Retrospective review of 51 neonates diagnosed with meconium ileus.
- Categorization into uncomplicated and complicated cases.
- Analysis of treatment modalities including nonoperative (Gastrografin enema, irrigation) and surgical interventions (resection, anastomosis, enterostomy).
Main Results:
- 51 neonates with meconium ileus were identified.
- Uncomplicated cases (24) and complicated cases (27) were analyzed.
- Nonoperative management with Gastrografin enema or enterotomy irrigation was successful in 9/24 uncomplicated cases.
- Survival rates were high: 92% for uncomplicated and 85% for complicated meconium ileus.
Conclusions:
- Nonoperative management, including Gastrografin enema and enterotomy irrigation, is effective for uncomplicated meconium ileus.
- These nonoperative methods can obviate the need for enterostomy in many cases.
- Improved survival rates highlight advancements in neonatal care for meconium ileus.
Abstract:
This report describes 51 neonates with meconium ileus and emphasizes a changing pattern of treatment and improved survival. Twenty-four neonates had uncomplicated meconium ileus due to inspissated meconium obstructing the distal ileum. Twenty-seven neonates had 41 complications of meconium ileus including volvulus (18), bowel atresia (13), perforation (5), and giant cystic meconium peritonitis (5). Nine patients with uncomplicated cases responded to nonoperative clearing of meconium using a meglumine diatrizoate (Gastrografin) enema. Six of 7 patients with enema failures underwent laparotomy, purse-string enterotomy, and intraluminal irrigation. The remaining 9 patients with uncomplicated meconium ileus had resection and enterostomy. Complicated cases were managed by resection and anastomosis (13) or enterostomy (14). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 85% for those with complicated meconium ileus. Nonoperative Gastrografin enema or enterotomy-irrigation can relieve obstruction in uncomplicated meconium ileus and avoid an enterostomy in most cases.