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Meconium ileus: laparotomy without resection, anastomosis, or enterostomy
Abstract:
During the 14 yr from 1965 through 1978, 49 infants presented shortly after birth with intestinal obstruction due to impacted meconium. Three of these patients did not have fibrocystic disease. Eight patients were cured by a Gastrografin enema. There were 18 patients who had complications that included associated atresia, volvulus, and/or peritonitis. Various operations were done including resection with either primary anastomosis or enterostomy or varieties of the foregoing. Twenty-three babies had the simple uncomplicated form of meconium ileus. Eleven of these underwent resection and six patients died. Twelve patients were treated by laparotomy, ileotomy through a purse-string suture and prolonged irrigations using acetylcysteine. Of this group only one succumbed. This latter course of management is recommended for patients with simple uncomplicated meconium ileus as it involves no resection, no enterostomy, nor any primary anastomosis.
Insights
Meconium ileus in infants can cause intestinal obstruction. Non-surgical management with acetylcysteine irrigations is recommended for simple cases, avoiding resection and improving outcomes.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Meconium ileus is a common cause of intestinal obstruction in newborns.
- It is frequently associated with fibrocystic disease, but non-fibrocystic cases exist.
- Complications include atresia, volvulus, and peritonitis, necessitating surgical intervention.
Purpose of the Study:
- To review the management and outcomes of infants with meconium ileus.
- To compare surgical and non-surgical treatment approaches.
- To identify optimal management strategies for simple versus complicated meconium ileus.
Main Methods:
- Retrospective review of 49 infants with meconium ileus from 1965-1978.
- Analysis of treatment modalities including Gastrografin enema, surgical resection, and non-surgical management with acetylcysteine irrigations.
- Categorization of patients into simple uncomplicated and complicated meconium ileus groups.
Main Results:
- Eight patients were successfully treated with a Gastrografin enema.
- Eighteen patients had complicated meconium ileus requiring surgery, with varied outcomes.
- For simple meconium ileus, non-surgical management (laparotomy, ileotomy, acetylcysteine irrigation) resulted in one death out of twelve patients, compared to six deaths out of eleven in the resected group.
Conclusions:
- Non-surgical management using laparotomy, ileotomy, and acetylcysteine irrigations is a safe and effective treatment for simple, uncomplicated meconium ileus.
- This approach avoids the morbidity associated with resection and primary anastomosis.
- Early diagnosis and appropriate management are crucial for improving infant survival rates in meconium ileus.