morphine and Enterocolitis

Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies.. A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001. Patients with HD were identified (n = 50), and a concurrent cohort of patients with idiopathic constipation (IC; n = 50) was selected. Pertinent features in patients with HD versus those with IC were cross tabulated using Pearson Chi2 testing (significance was P <.05).. Sixty percent of patients with HD and 15% of patients with IC experienced onset of symptoms in the first week of life. HD patients more frequently experienced delayed passage of meconium (P <.05), abdominal distension (P <.05), vomiting (P <.05), and transition zone on contrast enema (P <.05). All patients with HD had one or more of these significant features. In contrast, only 64% of patients with IC had one or more of these features. The classic triad of symptoms (ie, delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and one or more of these symptoms was present in 98% of HD patients. In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension.. A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation. The authors have shown that key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC. In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD.

Topics: Adolescent; Age of Onset; Barium Sulfate; Biopsy; Child; Child, Preschool; Cohort Studies; Constipation; Diagnosis, Differential; Enema; Enterocolitis; Fecal Impaction; Female; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Male; Meconium; Physical Examination; Rectum; Retrospective Studies; Unnecessary Procedures; Vomiting

To document causes of colic in equine neonates, evaluate clinical features of neonates managed medically versus surgically, determine short- and long-term survival rates for neonates with specific medical and surgical lesions, and assess ability of patients to achieve intended use.. Retrospective case series.. 137 client-owned equine neonates (< 30 days old) with a history of colic or signs of colic within 1 hour after hospital admission examined between 2000 and 2010.. Signalment, history, results of physical examination, laboratory data, ancillary diagnostic tests, details of treatment, primary diagnosis, concurrent diseases and short-term survival rate were obtained from the medical records. Long-term follow-up information was obtained through phone survey.. 137 neonates with colic were included. The majority (122 [89%]) of neonates were managed medically. The 3 most common diagnoses associated with colic were enterocolitis (37 [27%]), meconium-associated colic (27 [20%]), and transient medical colic (26 [19%]). The most common reason for surgery was small intestinal strangulating obstruction, and these neonates were more likely to have severe, continuous pain and were less responsive to analgesics. Concurrent diseases were common (87 [64%]) but did not significantly impact survival rate. Short-term survival rate was not significantly different between medically (75%) and surgically (73%) managed neonates. Long-term survival rate was excellent (66/71 [93%]) for horses that survived to hospital discharge. Most neonates surviving to maturity were used as intended (49/59 [83%]).. Most neonates examined for signs of colic can be managed medically. Short-term survival rate in medically and surgically treated neonates was good. Long-term survival rate of foals discharged from the hospital was excellent, with most achieving intended use.

Topics: Animals; Animals, Newborn; Colic; Enterocolitis; Female; Horse Diseases; Horses; Intestinal Obstruction; Male; Meconium; Retrospective Studies

Topics: Amniotic Fluid; Animals; Deglutition; Enterocolitis; Esophagus; Female; Fetal Diseases; Gastroesophageal Reflux; Gastroschisis; Intestines; Ligation; Meconium; Models, Animal; Pregnancy; Sheep

A case of meconial disease not associated with mucoviscidosis registered in 0.08% of perinatal autopsies is described in a premature girl who died 46 hours after her birth. Productive exudative meconial peritonitis that had developed due to intestinal wall perforation caused by meconium plug pressure was detected on the section. Microscopically, there were abundant squamous epithelial scales in the fibrinous exudate and commissures, whereas in the submucosal layer of the intestinal wall there were productive aseptic meconial granulomas whose components are squamous epithelial scales in addition to cellular elements. Searches for granulomas are made concurrently with examination of great quantities of histologic sections, but their detection is valuable for differential diagnosis of newborn ulcerous enterocolitis.

Topics: Enterocolitis; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Diseases; Meconium