morphine and Fecal-Impaction

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

We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid - small bowel atresia and developed severe faecal impaction in the post - operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.

Topics: Acetylcysteine; Chemical and Drug Induced Liver Injury; Cystic Fibrosis; Enema; Fecal Impaction; Free Radical Scavengers; Humans; Ileus; Infant, Newborn; Meconium

Although successful treatment of meconium ileus with Gastrografin enema has been attributed to the hypertonicity of this material, Tween 80, present in a 0.75% concentration, may be its most effective component. Tween 80 acts as a surface-active substance and stool emulsifier. An enema solution of 1%-2% Tween 80 and isotonic sodium diatrizoate has been effective in the relief of meconium or fecal mass obstruction in infants and children.

Topics: Adolescent; Child, Preschool; Diatrizoate; Enema; Fecal Impaction; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Polyethylene Glycols; Polysorbates

A case of meconium ileus equivalent in a 30-year old man is presented. The pathology and therapy for the condition are discussed.

Topics: Acetylcysteine; Adolescent; Adult; Age Factors; Child; Child, Preschool; Cystic Fibrosis; Fecal Impaction; Humans; Ileum; Infant; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Radiography; Respiration, Artificial

Topics: Bronchopneumonia; Child, Preschool; Cystic Fibrosis; Fecal Impaction; Humans; Infant, Newborn; Infant, Newborn, Diseases; Japan; Liver; Lung; Male; Meconium; Pancreas; Radiography

Topics: Acetylcysteine; Animals; Dogs; Fecal Impaction; Gastrointestinal Hemorrhage; Humans; Hydrogen Peroxide; Hyperemia; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Viscosity

Topics: Acetylcysteine; Anti-Bacterial Agents; Bronchi; Bronchial Diseases; Child; Cystic Fibrosis; Digestive System; Drainage; Fecal Impaction; Humans; Hyperglycemia; Intestinal Obstruction; Liver Cirrhosis; Lung; Lung Diseases; Meconium; Mucus; Pneumatosis Cystoides Intestinalis; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Therapy; Respiratory Tract Diseases; Salivary Glands; Sweat