morphine and Ileal-Diseases

Meconium peritonitis (MP) is defined as a sterile inflammatory reaction in the fetal abdomen that is seen in cases of intrauterine bowel perforation. Recently, there have been increasing numbers of fetuses with MP prenatally diagnosed by ultrasonography. Massive fetal ascites in MP may cause hydrops and hypoplastic lungs. However, antepartum management of MP has not yet been established. We encountered a fetus with MP and massive ascites. Repeated paracentesis between 29 weeks and 4 days and 31 weeks and 6 days of gestation prevented the progression to fetal hydrops and hypoplastic lungs, which may occur due to massive meconium ascites with an increased preload index. Amniocentesis was also performed in patients with polyhydramnios for treatment of preterm labor. These observations suggest that aggressive therapy can prolong the gestation period and improve MP treatment outcomes.

Topics: Adult; Ascites; Female; Fetal Diseases; Gestational Age; Humans; Ileal Diseases; Infant; Intestinal Perforation; Labor, Induced; Live Birth; Male; Meconium; Paracentesis; Peritonitis; Pregnancy; Reoperation; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed; Ultrasonography, Prenatal

We report a case of a 5-day-old infant male who presented with abdominal distention and inability to pass meconium. Barium enema revealed microcolon, and at surgery the etiology was found to be multiple proximal ileal atresia.

Topics: Barium Sulfate; Colon; Diagnosis, Differential; Enema; Humans; Ileal Diseases; Ileum; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Radiography

A case is presented in which extension of meconium peritonitis through muscular defects in the diaphragm lead to intrathoracic calcifications diagnosed sonographically at 23 weeks of gestation. There were three diaphragmatic defects, two small ones corresponded to foramina of Morgagni and one large posterior defect that did not correspond to the foramen of Bochdelak. There were three additional muscular defects: one in the rectus abdominus and two, bilaterally, in the loins. Despite long-standing fetal ascites and fresh intraperitoneal meconium at laparotomy, postoperative progress was uneventful. The baby did not have other dysmorphic features except for a single palmar crease, the chromosomes were normal, and the baby did not have cystic fibrosis. Follow-up examination at 10 months showed a thriving infant with mild hypotonia and developmental delay, but no respiratory or gastrointestinal problems.

Topics: Adult; Calcinosis; Cesarean Section; Chromosome Aberrations; Chromosome Disorders; Female; Hernia, Diaphragmatic; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Laparotomy; Male; Meconium; Peritonitis; Pregnancy; Thoracic Diseases; Tomography, X-Ray Computed; Ultrasonography

Topics: Ductus Arteriosus, Patent; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature; Intestinal Obstruction; Male; Meconium; Postoperative Complications; Radiography

Meconium ileus can be difficult to distinguish from ileal atresia on plain radiographs and on contrast enema. Both show a microcolon in the face of a small bowel obstruction. The treatment of the two is very different. Meconium ileus obstruction may be relieved medically by contrast enema; ileal atresia requires prompt surgical intervention. This study was made to determine if abdominal ultrasonography might be helpful in distinguishing between these two entities. Abdominal ultrasonograms from the past 10 years of all patients with these two diseases who were studied with preoperative ultrasonography at Arkansas Children's Hospital were reviewed. Six of 16 patients with meconium ileus had preoperative ultrasonograms. All six patients with meconium ileus had multiple loops of bowel filled with very echogenic thick meconium. Four of 22 patients with ileal atresia had preoperative ultrasonograms. These four patients with ileal atresia had dilated loops of bowel filled with fluid and air. None had a dilated bowel filled with thick echogenic contents. Preoperative abdominal ultrasonography is proposed as a simple method for distinguishing between these two disease entities with very different treatment plans.

Topics: Diagnosis, Differential; Humans; Ileal Diseases; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Meconium; Ultrasonography

Topics: Diagnosis, Differential; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Male; Meconium; Pneumoperitoneum; Testicular Hydrocele

Intestinal volvulus is a life-threatening emergency requiring prompt surgical management. Prenatal intestinal volvulus is rare, and most are secondary to intestinal atresia, mesenteric defect or without any underlying cause. Cystic fibrosis (CF) is known to cause digestive tract disorders. After birth, 10-15% of newborns with CF may develop intestinal obstruction within a few days of birth because of meconial ileus.

Topics: Adult; Anastomosis, Surgical; Cesarean Section; Cystic Fibrosis; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Intestinal Volvulus; Male; Meconium; Pneumoperitoneum; Pregnancy; Radiography; Treatment Outcome; Ultrasonography, Prenatal

This study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results.. This study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups.. Overall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person).. US-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.

Topics: Acetylcysteine; Birth Weight; Cathartics; Contrast Media; Diatrizoate Meglumine; Enema; Expectorants; Female; Gestational Age; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Iothalamic Acid; Male; Meconium; Radiography; Retreatment; Sodium Chloride; Time Factors; Treatment Outcome; Ultrasonography, Interventional

The significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung's disease and magnesium tocolysis. We reviewed our experience to attempt to identify any potential association with these conditions and to review our outcomes.. Using the International Classification of Diseases, Ninth revision, code for meconium obstruction, patient charts were identified during the 1998-2008 period. A total of 61 cases of MPS were found, after excluding 7 of meconium ileus. Data regarding the hospital course and outcomes were collected and analyzed.. Approximately 30% of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97% success. Only 2 patients required surgical intervention owing to worsening distension and subsequent peritonitis. When we stratified the patients according to gestational age of >36 and <36 wk, contrast barium enemas were performed 2.2 ± 1.8 versus 8.6 ± 7.8 d after birth (P = 0.003), respectively, and the lower gestational age patients had a longer length of stay. Contrast barium enema was still successful in 94% of patients with a gestational age of <36 wk. Magnesium tocolysis was noted in 16% of the cases, and Hirschsprung's disease was only found in 3.2% of patients.. Patients with MPS have excellent outcomes, independent of gestational age. Contrast barium enema remains the initial diagnostic and treatment of choice for patients with MPS. Also, although previous reports have shown a link between magnesium tocolysis and Hirschsprung's disease with MPS, our experience suggests otherwise.

Topics: Barium Sulfate; Cystic Fibrosis; Enema; Female; Hirschsprung Disease; Humans; Ileal Diseases; Incidence; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Retrospective Studies; Syndrome; Treatment Outcome

Topics: Cystic Fibrosis; Diabetes Mellitus, Type 1; Fatal Outcome; Female; Humans; Ileal Diseases; Intestinal Obstruction; Intestines; Meconium; Radiography; Young Adult

Various surgical methods are used to treat meconium ileus (MI), including resection with enterostomy (RES), primary anastomosis (RPA), and purse-string enterotomy with intra-operative lavage (PSI). The aim of this study is to discuss the surgical treatment of MI, based on our experience.. Of the 41 MI patients treated at our institution between 1984 and 2007, 18 had simple MI and 23 had complex MI. These groups were analyzed according to treatment modality, concentrating on length of hospital stay, complications [peritonitis, septicemia, adhesive small bowel obstruction (ASBO), and malabsorption/diarrhea], need for additional surgical procedures, mortality.. Of the 18 patients with simple MI, 7 (39%) were successfully treated with diluted Gastrografin® enema. The remaining 11 patients were treated surgically: two underwent RPA, of whom one died; five had RES, of whom one developed ASBO; four underwent PSI, of whom two developed peritonitis. In the complex MI group, 14 patients underwent RPA, with peritonitis occurring in three (one died); nine underwent RES, of whom two developed ASBO.. In patients with simple MI, conservative treatment with diluted Gastrografin® enema is an effective initial treatment in our hands. In case of failure, RES is advisable. Patients with complex MI are candidates for RES. RPA and PSI seem to have higher complication rates.

Topics: Female; Humans; Ileal Diseases; Ileus; Infant, Newborn; Male; Meconium; Retrospective Studies; Severity of Illness Index

Various definitions for distal intestinal obstruction syndrome (DIOS), meconium ileus equivalent, and constipation in patients with cystic fibrosis (CF) are used. However, an unequivocal definition for DIOS, meconium ileus equivalent, and constipation is preferred. The aims of this study were, therefore, to seek consensus on the definitions for DIOS and constipation in patients with CF and to determine the incidence, characteristics, and treatment of DIOS in a cohort of paediatric patients with CF.. During the 2005 European Society for Paediatric Gastroenterology, Hepatology, and Nutrition meeting in Porto a group of paediatric gastroenterologists discussed the definition of DIOS and constipation in CF. Subsequently, all patients younger than or equal to 18 years with complete DIOS according to the definition agreed upon and diagnosed during the years 2001 to 2005 in 8 CF centres were studied.. Distal intestinal obstruction syndrome was defined as an acute complete or incomplete faecal obstruction in the ileocaecum, whereas constipation was defined as gradual faecal impaction of the total colon. Fifty-one episodes of DIOS in 39 patients were recorded, giving an overall incidence of 6.2 (95% confidence interval, 4.4-7.9) episodes per 1000 patient-years. Of the 39 patients with DIOS, 20% experienced a relapse, 92% were pancreatic insufficient, 44% had a history of meconium ileus at birth, and 82% had a severe genotype. Conservative treatment was effective in 49 of 51 DIOS episodes (96%).. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition CF Working Group definitions of DIOS and constipation in CF are specific and make a clear distinction between these 2 entities. The incidence of DIOS in the present study was considerably higher than reported previously.

Topics: Constipation; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Genotype; Humans; Ileal Diseases; Ileus; Incidence; Intestinal Obstruction; Meconium; Multicenter Studies as Topic

Topics: Constipation; Cystic Fibrosis; Genotype; Humans; Ileal Diseases; Intestinal Obstruction; Meconium; Multicenter Studies as Topic; Mutation

Topics: Ammonium Sulfate; Humans; Ileal Diseases; Infant, Newborn; Intestinal Diseases; Lithiasis; Magnesium Compounds; Meconium

We are reporting the case of a neonate which died on 16th day of life due to a fatal evolution of a rare association of cystic fibrosis and Hirschsprung's disease.

Topics: Colonic Diseases; Cystic Fibrosis; Fatal Outcome; Hirschsprung Disease; Humans; Ileal Diseases; Ileus; Infant, Newborn; Male; Meconium

Topics: Base Sequence; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Gene Deletion; Heterozygote; Humans; Ileal Diseases; Infant, Newborn; Intestinal Diseases; Meconium; Models, Genetic; Molecular Sequence Data; Mutation; Neonatal Screening; Trypsinogen

Topics: Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Magnetic Resonance Imaging; Male; Meconium; Pregnancy

Topics: Anastomosis, Surgical; Calcinosis; Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Radiography; Ultrasonography

Guidelines for diagnosis and therapy of meconium obstruction in extremely low birth weight neonates are still not well established.. All low-birth-weight infants presenting with meconium obstruction over a 5-year period were reviewed retrospectively. Patients with meconium plug syndrome or cystic fibrosis were excluded.. Seven patients were identified. Average birth weight and gestational age were 874 g and 27.7 weeks, respectively. All were products of high-risk pregnancies, and 6 (86%) were delivered by cesarean section. All patients presented with distended abdomens without peritonitis. Abdominal films showed multiple distended intestinal loops without air-fluid levels in all cases. Three patients (43%) had contrast enemas, all showing microcolon. Nonoperative therapy, consisting of rectal irrigations and N-acetylcysteine per orogastric tube, succeeded in 3 patients who were obstructed for less than 10 days and failed in 1 patient obstructed for 12 days. Four patients, all obstructed for more than 10 days, underwent enterotomy and lavage (2), bowel resection and ileostomy (1), and initial peritoneal drainage for perforation followed by bowel resection (1). All patients survived with intact bowel function.. Extremely low-birth-weight infants with meconium obstruction can be diagnosed based on their typical clinical and plain radiographic characteristics, without need for a contrast enema. Nonoperative treatment is successful early in the course of the obstruction. In the absence of an intestinal complication, simple enterotomy and meconium evacuation effectively treats long-standing obstruction.

Topics: Algorithms; Enema; Humans; Ileal Diseases; Ileum; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Meconium; Radiography; Retrospective Studies

The etiology of meconium obstruction without cystic fibrosis is unclear. Interstitial cells of Cajal (ICC) function as pacemakers in gut motility and may play a role in the pathophysiology of the disease.. The ICC were examined by immunohistochemical staining with anti-c-kit antibody in the bowel walls of 6 neonates who had meconium obstruction without cystic fibrosis, and the results were compared with specimens from normal neonates (n = 2).. Six patients underwent ileostomy between 2 and 15 days after birth, and 5 of them presented with microcolon. Ganglion cells were present in the ileum and colon. Whereas ICC were evenly distributed in the control specimens, they were not seen at the time of ileostomy in the colons of 2 patients, and the other 4 showed scanty distribution in muscle layers. However, ileum showed normal distribution of ICC in all patients. The ileostomies were closed between 39 and 104 days of age, and the ICC distribution was changed to a normal pattern in the colons of all 6 patients. Their bowel movements were restored to normal after closure.. The findings of this study suggest that delayed maturity of ICC may be a cause of meconium obstruction without cystic fibrosis.

Topics: Coiled Bodies; Colonic Diseases; Female; Gastrointestinal Motility; Humans; Ileal Diseases; Ileostomy; Immunohistochemistry; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium

A female neonate developed abdominal distension with vomiting. She was suffering from meconium ileus and cystic fibrosis.

Topics: Abdomen; Cystic Fibrosis; Female; Humans; Ileal Diseases; Ileum; Infant, Newborn; Intestinal Obstruction; Meconium; Vomiting

We report a case of in utero paracentesis of ascites in a fetus with meconium peritonitis due to volvulus at 34 weeks which resulted in the correction of an abnormal fetal heart rate pattern and enabled vaginal delivery by preventing abdominal dystocia. The intrauterine intervention also helped to establish the diagnosis and potentially reduced the respiratory compromise after birth.

Topics: Adult; Arrhythmias, Cardiac; Diagnosis, Differential; Female; Fetal Diseases; Fetal Monitoring; Heart Rate, Fetal; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Paracentesis; Peritonitis; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Twins

A case of twin-to-twin transfusion syndrome with intrauterine death of one twin and meconium peritonitis and intravascular disseminated coagulation in the other twin is reported. Meconium peritonitis follows to bowel perforation, caused by segmental severe hypoplasia of muscular layer. The Authors suggest that this structural alteration of bowel wall could be an expression of inequal distribution of some cells between the two twins, during embrional development.

Topics: Adult; Colon; Colonic Diseases; Diseases in Twins; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Fetal Death; Fetal Diseases; Fetofetal Transfusion; Hemoperitoneum; Humans; Ileal Diseases; Ileum; Immunoenzyme Techniques; Infant, Newborn; Intestinal Perforation; Meconium; Muscle, Smooth; Peritonitis; Polyhydramnios; Postoperative Complications; Pregnancy; Twins, Monozygotic

Topics: Abdomen; Adult; Cysts; Female; Fetal Diseases; Humans; Ileal Diseases; Intestinal Obstruction; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Of 36 neonates with meconium ileus secondary to cystic fibrosis treated over a 10-year period, twenty-one (58%) had simple uncomplicated disease while fifteen (42%) had complications which included perforation (5), volvulus (6) and atresia (5). Gastrografin enema was employed in 20 infants with relief of obstruction in 8 (40%). Operative procedures consisted of resection and primary anastomosis in seventeen patients, stomas were fashioned in six, three had an enterotomy with irrigation only and two had Bishop-Koop enterostomy. Post-operative complications developed in 5 (18%) of these 28 patients. The overall survival rate was 97%. The one death occurred in an infant with short bowel syndrome, patent ductus arteriosus, hydrocephalus and pulmonary damage. There were eight additional patients who had meconium obstruction in the absence of cystic fibrosis.

Topics: Cystic Fibrosis; Diatrizoate Meglumine; Enema; Enterostomy; Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; London; Male; Meconium; Retrospective Studies; Survival Rate

The authors reviewed their experience with meconium peritonitis (MP) diagnosed in utero to define criteria for prenatal and postnatal management. Prenatal diagnosis was made by identifying abdominal calcification on serial ultrasound examinations in nine fetuses, between 18 and 37 weeks' gestation. Cases without associated bowel abnormalities were considered "simple MP" and those with bowel abnormalities were considered "complex MP." Five cases of simple MP were identified at 18, 23, 30, 34, and 37 weeks' gestation. These five fetuses were delivered at term and had normal abdominal examinations. Abdominal radiographs were obtained in three showing normal bowel gas patterns, and abdominal calcifications in only two. All five patients were fed uneventfully. Four cases of complex MP were identified at 26, 26, 31, and 31 weeks' gestation. All four fetuses had dilated loops of bowel. Two of the four had meconium cysts, one of which was associated with ascites and the other with polyhydramnios. Shortly after birth both infants with meconium cysts required ileal resection and ileostomy for ileal atresia and ileal perforation, respectively. The remaining two infants had no evidence of dilated bowel, meconium cyst, or ascites on postnatal radiograph and were fed uneventfully. These data suggest that only 22% of fetuses with a prenatal diagnosis of MP develop complications that require postnatal operation. Gestational age at diagnosis does not correlate with postnatal outcome. Fetuses with complex MP are at increased risk for postnatal bowel obstruction and perforation.

Topics: Ascites; Calcinosis; Cysts; Dilatation, Pathologic; Female; Fetal Diseases; Follow-Up Studies; Gases; Gestational Age; Humans; Ileal Diseases; Ileum; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestinal Perforation; Intestines; Male; Meconium; Peritonitis; Polyhydramnios; Pregnancy; Pregnancy Outcome; Radiography; Ultrasonography, Prenatal

Neuroblastoma, Hirschsprung's disease, and central hypoventilation (Ondine's curse) are considered aberrations of neural crest cell growth, migration, or differentiation, and as such are considered to be under the general heading of neurocristopathy. Their combined occurrence in a newborn infant presenting with total colonic aganglionosis, central hypoventilation, and multifocal neuroblastoma had not been reported previously. A 2.3-kg white full-term girl required endotracheal intubation because of persistent apnea in the first hours of life. She had progressive abdominal distension and failure to pass meconium; a barium enema was performed, which showed microcolon with meconium pellets at the distal ileum. During laparotomy the distal ileum was found to be obstructed with inspissated meconium; an ileostomy and appendectomy were performed. The resected specimens were aganglionic. An additional 20 cm of aganglionic ileum was removed, and a normally innervated ileostomy was constructed. Numerous attempts at extubation failed because of apnea. The results of an extensive apnea workup, including electroencephalogram, magnetic resonance imaging (MRI), bronchoscopy, and pH probe study, were normal. Sleep studies showed congenital central hypoventilation syndrome, and the patient underwent a tracheostomy. At 3 months, an abdominal ultrasound examination performed within a septic workup showed a right suprarenal mass extending across the midline. Thoracic and abdominal MRI scans showed large bilateral adrenal and posterior mediastinal masses. The serum catecholamines and ferritin level were markedly elevated, suggestive of neuroblastoma. In light of the child's multiple problems, the family chose to forgo further workup (including a tissue biopsy) and therapy. In the following 2 months her tumor load rapidly progressed, and she died of respiratory insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenal Gland Neoplasms; Colonic Diseases; Female; Follow-Up Studies; Hirschsprung Disease; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Meconium; Mediastinal Neoplasms; Neural Crest; Neuroblastoma; Sleep Apnea Syndromes; Tracheostomy

Although meconium ileus in the absence of cystic fibrosis is considered a rare event, it was found that eight of 37 (21.6%) newborn infants with meconium ileus had no laboratory or clinical evidence of cystic fibrosis.

Topics: Female; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature; Intestinal Obstruction; Male; Meconium

We identified 21 children (14 boys and seven girls) with long-segment Hirschsprung's disease defined as aganglionosis extending proximal to the ileocecal valve. Long-segment Hirschsprung's disease is difficult to diagnose and treat; symptoms may be mild, and diagnosis delayed. Abdominal distention and constipation or delayed passage of meconium are the most common symptoms. Radiologic studies are unreliable in establishing the diagnosis. The morbidity rate is high because of the high transition zone and short gut. The long-term outcome of patients after the standard Duhamel procedure is satisfactory, except with extremely high transition zones. Pull-through procedures should not be performed in the small infant, but should be delayed until patients are old enough to be continent.

Topics: Abdomen; Constipation; Female; Follow-Up Studies; Hirschsprung Disease; Humans; Ileal Diseases; Ileocecal Valve; Ileostomy; Infant; Infant, Newborn; Male; Meconium; Survival Rate; Vomiting

Cystic fibrosis patients born with meconium ileus (MI) have had an improved outcome over the last three decades. The authors reviewed the impact of surgical management and long-term nutritional care on the survival of patients with MI. Of the 59 cases of MI seen from 1959 to 1989, 48 cases were managed operatively using either the Bishop-Koop ileostomy (BK), the Mikulicz ileostomy, primary resection and anastomosis (RA), or ileostomy. Six-month survival of MI has improved from 37% to 100%. Nonoperative cases (n = 11) had 100% long-term survival. The RA survivors required less late operative intervention (20%) as compared with other surgical patients (81%). A comparison of serial growth percentiles of CF patients with MI with those of their non-MI CF peers showed similar long-term decreases. These data confirm: (1) There is an improved survival for MI independent of the surgical procedure; (2) The BK ileostomy is an effective and time-tested MI treatment; (3) Primary resection and anastomosis in selected cases may have a lower surgical morbidity rate; and (4) Meconium ileus does not adversely affect the long-term nutritional outcome of CF patients.

Topics: Chi-Square Distribution; Cystic Fibrosis; Female; Humans; Ileal Diseases; Infant; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Nutritional Status; Retrospective Studies; Survival Analysis; Treatment Outcome

During 13 years, 47 infants were treated for mechanical ileus resulting from intestinal obstruction located proximally to the coecum (duodenal obstruction, malrotation, jejuno-ileal obstruction and meconium ileus). The mortality and morbidity were low. A total of three infants died; all of them in the immediate postoperative period. One infant died on account of rupture of the anastomosis; in two infants, death was caused by pulmonary complications and disseminated intravasal coagulation. Seven reoperations were performed and among these five infants on account of adhesions-/fibrous band ileus. At follow-up examination five infants were slightly underweight and retarded in growth; only one child had troublesome gastrointestinal problems. We recommend the use of antenatal ultrasound in the 30th week of gestation more frequently and always when polyhydramnios is present. This should raise the suspicion of gastrointestinal obstruction. Postnatal screening for associated congenital anomalies should also be done, since these are the most frequent cause of death in this patient category.

Topics: Duodenal Obstruction; Female; Follow-Up Studies; Humans; Ileal Diseases; Infant; Infant, Newborn; Intestinal Obstruction; Jejunal Diseases; Male; Meconium; Prognosis

We report a case of dysgenetic congenital hypothyroidism associated with cystic fibrosis. Impaired exocrine pancreatic secretion and/or transit abnormalities secondary to the treatment of meconium ileus resulted in decreased absorption of L-thyroxine and difficulties in management of hypothyroidism.

Topics: Congenital Hypothyroidism; Cystic Fibrosis; Humans; Hypothyroidism; Ileal Diseases; Infant, Newborn; Intestinal Pseudo-Obstruction; Male; Meconium; Pancreas; Pancreatic Function Tests; Thyroid Function Tests; Thyroid Gland

Topics: Anastomosis, Surgical; Female; Hirschsprung Disease; Humans; Ileal Diseases; Ileostomy; Infant, Newborn; Intestinal Obstruction; Intestines; Meconium; Myenteric Plexus; Postoperative Complications; Reoperation

This report describes 51 neonates with meconium ileus and emphasizes a changing pattern of treatment and improved survival. Twenty-four neonates had uncomplicated meconium ileus due to inspissated meconium obstructing the distal ileum. Twenty-seven neonates had 41 complications of meconium ileus including volvulus (18), bowel atresia (13), perforation (5), and giant cystic meconium peritonitis (5). Nine patients with uncomplicated cases responded to nonoperative clearing of meconium using a meglumine diatrizoate (Gastrografin) enema. Six of 7 patients with enema failures underwent laparotomy, purse-string enterotomy, and intraluminal irrigation. The remaining 9 patients with uncomplicated meconium ileus had resection and enterostomy. Complicated cases were managed by resection and anastomosis (13) or enterostomy (14). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 85% for those with complicated meconium ileus. Nonoperative Gastrografin enema or enterotomy-irrigation can relieve obstruction in uncomplicated meconium ileus and avoid an enterostomy in most cases.

Topics: Cystic Fibrosis; Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Male; Meconium

Three neonates with meconium ileus who failed to respond to non-operative measures were successfully treated by appendicectomy and irrigation with Gastrografin into the small bowel via the appendix stump. The meconium was emptied out and the stump ligated. This method avoids enterotomy, enterostomies or resection of bowel. The post-operative course is simplified and hospital stay decreased. Removal of the appendix precludes future disease of this organ which may be problematic in patients with cystic fibrosis.

Topics: Appendectomy; Appendix; Combined Modality Therapy; Diatrizoate Meglumine; Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Intubation, Gastrointestinal; Male; Meconium; Therapeutic Irrigation

Topics: Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy

Five neonates with uncomplicated meconium ileus were successfully managed by laparotomy and T tube ileostomy. This method seems to offer advantages over other surgical techniques used in the management of uncomplicated meconium ileus that fails to respond to decompression by Gastrografin enema.

Topics: Humans; Ileal Diseases; Ileostomy; Infant; Infant, Newborn; Intestinal Obstruction; Intubation; Meconium; Therapeutic Irrigation

Spontaneous, focal gastrointestinal perforation occurred in six very low birth weight infants. The first recognized clinical sign of perforation in five of the six infants was striking blue-black discoloration of the abdominal wall. In all cases the clinical and radiographic presentations, as well as the histologic findings, were distinct from those associated with necrotizing enterocolitis. All 4 infants who underwent exploratory laparotomy and repair had excellent surgical outcomes.

Topics: Colonic Diseases; Female; Humans; Ileal Diseases; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Intestinal Perforation; Male; Meconium; Peritonitis

Topics: Adult; Calcinosis; Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Ultrasonography

Ultrasonography has proven to be a helpful imaging modality in evaluating the child with a distended gasless abdomen. The presence of an unsuspected mass can easily be detected as well as the presence of ascites and/or abnormally dilated loops of small bowel. Thickened loops of bowel can also be easily detected in the abdomen with very little gas. Closed loop obstruction and intussusception, as well as meconium ileus equivalent (distal intestinal obstruction syndrome), are described.

Topics: Abdomen; Child, Preschool; Female; Humans; Ileal Diseases; Infant; Infant, Newborn; Intestinal Obstruction; Intussusception; Male; Meconium; Mesenteric Cyst; Ultrasonography

In contrast to bloatedness and steatorrhoea the meconium ileus equivalent is a less well known gastrointestinal complication in cystic fibrosis and thus less frequently correctly diagnosed. The term, first used by Jensen in 1962, notifies partial or complete obstruction due to increasing viscosity of gut contents. The occurrence of the meconium ileus equivalent increases with age (approx. 10%), recurrences are possible. Among 73 patients with cystic fibrosis 8 patients with ileus equivalents were observed, two of them had a recurrence Surgery was performed only in one case. In all other patients the intestinal obstruction was relieved by oral and enema administration of N-acetylcysteine.

Topics: Acetylcysteine; Adolescent; Child; Child, Preschool; Cystic Fibrosis; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Ileal Diseases; Intestinal Obstruction; Male; Meconium; Recurrence

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.

Topics: Cystic Fibrosis; Humans; Ileal Diseases; Ileostomy; Infant, Newborn; Intestinal Obstruction; Laparotomy; Meconium; Therapeutic Irrigation

Topics: Adult; Cystic Fibrosis; Diagnosis, Differential; Humans; Ileal Diseases; Intestinal Obstruction; Male; Meconium

Seven cases of increased echogenicity in the fetal abdomen detected on prenatal sonography were reviewed for findings and causes. In four cases, the findings corresponded to calcification secondary to meconium peritonitis, infection, or unknown cause. One infant with meconium ileus had inspissated but noncalcified meconium corresponding to the increased echoes. In two cases, follow-up prenatal sonography was normal, and the neonate was also normal. Eight cases from the literature with increased echogenicity in the fetal abdomen were also reviewed: Two cases were secondary to meconium ileus, and six were caused by meconium peritonitis. Increased abdominal echogenicity on prenatal sonography may result from various processes that may affect obstetric and neonatal management.

Topics: Abdomen; Calcinosis; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Meconium; Pregnancy; Ultrasonography

Topics: Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Meconium; Ultrasonography

Neonatal intussusception in premature infants is uncommon and may mimic other abdominal disorders. We present a case of intussusception in a very low birthweight neonate. Presenting signs initially suggested necrotizing enterocolitis and meconium disease, and the diagnosis was confirmed at laparotomy.

Topics: Humans; Ileal Diseases; Infant, Newborn; Infant, Premature, Diseases; Intussusception; Male; Meconium; Radiography

Intraluminal meconium calcification of unknown mechanism is reported in three neonates who did not have distal intestinal obstruction. The condition was benign in all three cases and did not require surgical intervention. This new form of intra-abdominal calcification should be differentiated from other forms that invariably are due to surgical disorders.

Topics: Calcinosis; Colonic Diseases; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature, Diseases; Intestinal Diseases; Male; Meconium; Radiography

Topics: Cystic Fibrosis; Diagnosis, Differential; Hirschsprung Disease; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium

Two neonates with clinical features of meconium plug syndrome (MPS) were found to have ileocolic intussusception associated with meconium plugs inspissated in the distal ileum. Hydrostatic reduction of the intussusception relieved the intestinal obstruction. Cystic fibrosis was excluded by sweat test and follow-up.

Topics: Female; Humans; Ileal Diseases; Infant, Newborn; Infant, Newborn, Diseases; Intussusception; Meconium; Radiography; Syndrome

A study of 29 neonates with intestinal obstruction has shown that a massively dilated, bulbous terminal segment of bowel is characteristic of neonatal infestinal obstruction of congenital origin. The sign is an important diagnostic indicator but its absence does not exclude intestinal atresia.

Topics: Dilatation, Pathologic; Humans; Ileal Diseases; Ileum; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Jejunal Diseases; Jejunum; Meconium; Radiography; Retrospective Studies

Eleven cases of neonatal intestinal obstruction associated with a white ileal meconium plug are described; 6 of these presented with complications--such as, giant meconium pseudocyst, perforation, volvulus, or atresia. Most of these complications are presumed to have arisen during the intrauterine period. Only one patient could be relieved of the ileal meconium plug by enemas. The condition of ileal meconium plug is not as benign as a meconium plug in the rectum or distal colon. A plea is made to restrict the name meconium plug syndrome to cases in which the meconium plug is white and chalky and the consequent intestinal obstruction can be relieved by enemas, without evidence of intestinal dysfunction in later life.

Topics: Enema; Female; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Syndrome

Topics: Adult; Ascites; Calcinosis; Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileal Diseases; Infant, Newborn; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Ultrasonography

Topics: Cystic Fibrosis; Humans; Ileal Diseases; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium

Topics: Humans; Ileal Diseases; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Peritonitis; Prognosis; Radiography