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Meconium ileus--a rare cause of neonatal intestinal obstruction in Malaysia
Abstract:
Meconium ileus, rare in Malaysia, accounts for 3.7% of all neonatal intestinal obstructions (excluding imperforate anus) seen in the University Hospital, Kuala Lumpur, from 1980-1990. This paper retrospectively reviews our clinical experience with 5 cases of meconium ileus seen over a 12-year period from 1980-1991 in the University Hospital, Kuala Lumpur. Three of the neonates were Malays, and two were Punjabis. Four of them were full-term and one preterm. The birth weights ranged from 1900 to 3700 g, with a mean of 2670 g. One of them also had a sibling with meconium ileus. Two of them were found to have foetal ascites and one had intestinal obstruction, antenatally by ultrasonography. The remaining two were symptomatic soon after birth. Extensive calcification was observed on plain abdominal radiographs in three babies and dilated bowels in the other two. All of them underwent laparotomy and uncomplicated meconium ileus was confirmed in two cases, meconium peritonitis in two and one meconium pseudocyst in addition to meconium peritonitis. There was one intraoperative death, and one long-term survivor who did not have cystic fibrosis. The remaining three did not have additional features suggestive of cystic fibrosis, and finally succumbed to respiratory infection. Sweat test was not done to confirm the diagnosis for logistic reasons. The management of such patients proved to be a challenge to clinicians because of the rarity of this condition.
Insights
Meconium ileus is a rare neonatal intestinal obstruction in Malaysia. This review of five cases highlights diagnostic challenges and varied outcomes in affected neonates.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Meconium ileus is a rare cause of neonatal intestinal obstruction.
- It accounts for 3.7% of neonatal intestinal obstructions in Malaysia.
- This study reviews clinical experience with five meconium ileus cases at University Hospital, Kuala Lumpur.
Purpose of the Study:
- To retrospectively review clinical experience with meconium ileus.
- To analyze the presentation, diagnosis, and management of meconium ileus in neonates.
- To highlight the challenges in managing this rare condition.
Main Methods:
- Retrospective case review of five neonates with meconium ileus from 1980-1991.
- Analysis of clinical data, including antenatal findings, birth details, radiological findings, surgical findings, and outcomes.
- Review of diagnostic challenges and management strategies.
Main Results:
- Five cases of meconium ileus were identified over 12 years.
- Presentations included uncomplicated meconium ileus, meconium peritonitis, and meconium pseudocyst.
- Antenatal ultrasonography detected fetal ascites or intestinal obstruction in two cases.
- Radiographs showed calcification or dilated bowels.
- One intraoperative death occurred; one long-term survivor did not have cystic fibrosis.
- Three neonates succumbed to respiratory infection, with sweat tests not performed due to logistical reasons.
Conclusions:
- Meconium ileus management presents a clinical challenge due to its rarity.
- Outcomes varied, with some neonates developing complications like meconium peritonitis.
- The study underscores the need for prompt diagnosis and management despite diagnostic limitations.