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Meconium ileus: is a stoma necessary?
Insights
This study reviewed 38 infants with cystic fibrosis and meconium ileus. A non-surgical approach using N-acetylcysteine irrigation and a Fogarty catheter is recommended for simple meconium ileus.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Meconium ileus is a common initial manifestation of cystic fibrosis.
- Management strategies for meconium ileus have evolved over time.
- Distinguishing between simple and complicated meconium ileus is crucial for treatment selection.
Purpose of the Study:
- To evaluate the management and outcomes of infants with meconium ileus.
- To compare different treatment modalities for simple and complicated meconium ileus.
- To identify an optimal treatment strategy for uncomplicated meconium ileus.
Main Methods:
- Retrospective review of 38 infants treated for meconium ileus between 1970 and 1984.
- Categorization of patients into simple and complicated meconium ileus groups.
- Analysis of surgical interventions, including resection, anastomosis, enterostomy, and irrigation techniques.
Main Results:
- 34% of patients had complicated meconium ileus, requiring surgical intervention.
- 40% success rate for Gastrografin enema in uncomplicated cases.
- A technique involving laparotomy, enterotomy, N-acetylcysteine irrigation, and Fogarty catheter evacuation showed no mortality in the simple meconium ileus group.
Conclusions:
- Surgical intervention is necessary for complicated meconium ileus.
- Gastrografin enema has limited success in uncomplicated meconium ileus.
- Laparotomy with N-acetylcysteine irrigation and Fogarty catheter evacuation is a safe and effective method for managing simple meconium ileus.
Abstract:
During the 15 years from 1970 to 1984, 38 infants, all with cystic fibrosis, were treated for meconium ileus at The Montreal Children's Hospital and Ste-Justine Hospital for Children. Thirteen patients (34%) had complicated meconium ileus that included 7 perforations (2 colon, 5 ileum), 4 volvulus, and 2 atresia with meconium pseudocyst. In this group, various operations were done: resection with primary anastomosis for atresia, or resection with enterostomy for peritonitis or volvulus. One died shortly after surgery. Of 25 patients with uncomplicated meconium ileus (66%), one died shortly after arrival from respiratory distress, leaving 24 patients available for study. Gastrografin enema was attempted on 20 patients with eight successes (40%). Of the remaining 16 patients with unresolved meconium ileus, nine were treated with laparotomy and ileostomy, and one with laparotomy and T-tube irrigation. Six patients were treated by laparotomy and enterotomy for irrigation with N-acetylcysteine and evacuation by Fogarty catheter, a technique not widely used. No one succumbed in this group. This latter method of management is recommended for patients with simple uncomplicated meconium ileus.