morphine and Intestinal-Diseases

Intestinal obstruction in the newborn infant may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal small left colon syndrome, and Hirschsprung's disease. Neonates with unrecognised intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and appropriate surgical treatment becomes more hazardous. Early diagnosis depends largely on the prompt detection of obstructive manifestations by the clinician and the subsequent accurate interpretation of radiographic findings by the radiologist. Plain film of the abdomen is often helpful in determining the level of obstruction and usually dictates, together with clinical symptoms, the choice of the contrast study firstly to perform. In this article we will review the clinical and radiological signs of different pathological conditions causing intestinal obstruction in the newborn.

Topics: Colon; Constriction, Pathologic; Contrast Media; Cysts; Hirschsprung Disease; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Intestines; Meconium; Pancreas; Radiography; Syndrome; Torsion Abnormality

Many different pathophysiologic conditions can affect the neonatal intestinal tract and ultimately require surgical intervention. The symptomatology is primarily that of bowel dysfunction and obstruction. A thorough understanding of these disease processes is necessary of the managing physician. With this knowledge, a systematic course of resuscitation, evaluation, and treatment can be instituted, usually with predictably gratifying results for patient, family, and physician alike.

Topics: Duodenal Obstruction; Enterocolitis, Pseudomembranous; Fluid Therapy; Hirschsprung Disease; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Jejunum; Meconium; Resuscitation

Topics: Adolescent; Adult; Appetite; Child; Child, Preschool; Cystic Fibrosis; Diabetes Complications; Female; Growth Disorders; Humans; Hypertension, Portal; Infant; Infant, Newborn; Intestinal Diseases; Intestinal Obstruction; Intussusception; Lactose Intolerance; Liver Cirrhosis; Male; Meconium; Pancreas; Pancreatitis; Rectal Prolapse

Topics: Abdomen; Adolescent; Adult; Child; Child, Preschool; Cystic Fibrosis; Fatty Liver; Feces; Humans; Infant; Intestinal Absorption; Intestinal Diseases; Intestinal Mucosa; Intestinal Obstruction; Intestines; Lactose Intolerance; Meconium; Metabolism, Inborn Errors; Pain; Pancreas; Prognosis; Rectal Prolapse

Intraamniotic meconium has been responsible for intestinal damage in gastroschisis and meconium-dependent intestinal ischemia has been proposed to induce additional intestinal damage in gastroschisis. This study is aimed to determine the effects of lipid and water-soluble meconium subfractions on the contractility of the superior mesenteric artery (SMA).. The study was conducted on 18-day fertilized chick embryos (Gallus Domesticus). Meconium is fractioned into water and lipid-soluble components. Only one SMA tissue was prepared from each embryo and suspended in the organ bath. Isometric contraction responses (ICR) were created in SMA tissues by one hour of incubation in Krebs-Henseleit solution for each group. Groups consisted of control, meconium, water-soluble meconium subfraction and lipid-soluble meconium subfraction. ICR of the SMA specimens were evaluated with a transducer-amplifier system on a computer. The data were expressed (mean±1SD) as milliNewton (mN).. The ICR of the meconium, water-soluble meconium subfraction and lipid-soluble meconium subfraction groups were significantly high when compared to the control group (p<0.01). The meconium and water-soluble meconium subfraction created more contraction response than the lipid-soluble meconium subfraction (p<0.01). The ICR of the meconium group was not different from the ICR of the water-soluble meconium subfraction group (p>0.05).. Water-soluble meconium subfraction has a profound vasoconstrictor effect on the SMA compared to the lipid-soluble meconium subfraction.

Topics: Animals; Chick Embryo; Gastroschisis; Glucose; Intestinal Diseases; Intestines; Lipids; Meconium; Mesenteric Artery, Superior; Tromethamine; Vasoconstriction; Water

It is unclear which substances in meconium are responsible for intestinal damage in gastroschisis. An experimental study was designed to investigate the effects of the lipid or water soluble subfractions of meconium on the intestines of gastroschisis in a chick model.. Meconium was pooled, homogenated, rota-evaporated dry and diluted. Meconium subfractions were obtained from water soluble and lipid soluble extracts of the meconium. Five days old fertilized chick embryos were used and divided into 5 groups: control, sham, water soluble meconium subfraction, lipid soluble meconium subfraction and whole meconium. All embryos were extirpated on the 18days and the intestines were harvested for histopathological examination. Serosal thickness was measured under light microscopy.. Serosal thickness of the meconium (36.36±2.8μm), the water soluble meconium (14.15±0.93μm) and the lipid soluble meconium (23.88±1.69μm) subfractions groups were significantly increased compared with the control (7.47±0.68μm) and the sham (7.48±0.71μm) groups (p<0.001). Serosal thickness of the lipid soluble meconium subfraction group was significantly increased compared with the water soluble meconium subfraction group (p<0.001). Serosal thickness of the meconium group was significantly increased compared to both the water and the lipid soluble meconium subfraction groups (p<0.001).. Lipid soluble meconium subfraction induces more intestinal damage compared to water soluble meconium subfraction.

Topics: Animals; Chick Embryo; Gastroschisis; Intestinal Diseases; Intestines; Lipids; Meconium; Solubility; Water

Enterolithiasis is an uncommon finding of a dilated hyperechogenic bowel with multiple ball-like echogenic structures at a routine prenatal check-up using ultrasonography. We here report a case of prenatally diagnosed enterolithiasis at 18 weeks of gestation, showing multiple hyperechogenic foci rolling within the bowel fluid after peristalsis. The size of the dilated bowel gradually increased during pregnancy. Magnetic resonance image demonstrated the dilated lower bowel with blind-ending rectum. A postnatal contrast medium study with retrograde urethrography revealed a middle imperforate anus and a rectourethral fistula. A careful examination, even before 20 weeks of gestation, is extremely useful in demonstrating intraluminal coarse calcifications within an echogenic bowel.

Topics: Adult; Calcinosis; Female; Humans; Intestinal Diseases; Meconium; Pregnancy; Pregnancy Trimester, Second; Ultrasonography, Prenatal

When abdominal distention occurs or bowel obstruction is suspected in the neonatal period, a water-soluble contrast enema is helpful for diagnostic and therapeutic purposes. The water-soluble contrast medium is evacuated through the anus as well as excreted via the kidneys in some babies. This study was designed to evaluate the incidence of renal excretion after enemas using water-soluble contrast media and presume the causes.. Contrast enemas using diluted water-soluble contrast media were performed in 23 patients under 2 months of age. After the enema, patients were followed with simple abdominal radiographs to assess the improvement in bowel distention, and we could also detect the presence of renal excretion of contrast media on the radiographs. Reviewing the medical records and imaging studies, including enemas and consecutive abdominal radiographs, we evaluated the incidence of renal excretion of water-soluble contrast media and counted the stay duration of contrast media in urinary tract, bladder, and colon.. Among 23 patients, 12 patients (52%) experienced the renal excretion of water-soluble contrast media. In these patients, stay-in-bladder durations of contrast media were 1-3 days and stay-in-colon durations of contrast media were 1-10 days, while stay-in-colon durations of contrast media were 1-3 days in the patients not showing renal excretion of contrast media. The Mann-Whitney test for stay-in-colon durations demonstrated the later evacuation of contrast media in the patients with renal excretion of contrast media (p = 0.07). The review of the medical records showed that 19 patients were finally diagnosed as intestinal diseases, including Hirschsprung's disease, meconium ileum, meconium plug syndrome, and small bowel atresia or stenosis. Fisher's exact test between the presence of urinary excretion and intestinal diseases indicated a statistically significant difference (p = 0.04).. The intestinal diseases causing bowel obstruction may increase the water-soluble contrast media's dwell time in the bowel and also increase urinary excretion.

Topics: Contrast Media; Diatrizoate Meglumine; Enema; Female; Hirschsprung Disease; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestine, Small; Male; Meconium; Radiography, Abdominal; Renal Elimination

The aim of the study was to determine whether longitudinal measurements of fecal S100A12, a damage-associated molecular pattern protein, which is released from neutrophils or monocytes under stress, can detect very-low-birth-weight (VLBW) infants at risk for intestinal distress apart from necrotizing enterocolitis.. This prospective study included 46 VLBW infants with intestinal distress and 49 reference patients. Meconium and stool samples were collected prospectively on alternate days for 4 weeks, and fecal S100A12 was measured by enzyme-linked immunosorbent assay.. Gestational age and weight at birth were significantly lower in patients with intestinal distress when compared to unaffected reference infants. Median levels of fecal S100A12 were significantly higher in patients with intestinal distress at onset of disease and before compared with unaffected reference infants. Median levels of fecal S100A12 declined steadily to baseline levels within 2 weeks after disease onset. The ideal cutoff value for identifying patients with intestinal distress within 7 days before disease onset was 60 μg/kg (sensitivity 0.73; specificity 0.55).. Fecal S100A12 levels are increased in VLBW infants with intestinal distress; however, the potential for S100A12 as an early biomarker is largely limited by overlaps between values of infants with intestinal distress and the reference population.

Topics: Biomarkers; Birth Weight; Enzyme-Linked Immunosorbent Assay; Feces; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Very Low Birth Weight; Intestinal Diseases; Intestinal Mucosa; Leukocytes; Longitudinal Studies; Male; Meconium; Monocytes; Neutrophils; Prospective Studies; Reference Values; S100 Proteins

Contact with amniotic fluid causes intestinal damage (ID) in fetuses with gastroschisis. Intraamniotic meconium has been shown to be responsible for ID, and ID has been shown to correlate with intraamniotic meconium concentrations. ID can be prevented by lowering the intraamniotic meconium concentration. A new method to lower intraamniotic meconium concentration might consist in the induction of fetal diuresis with intraamniotic diuretic injection. This hypothesis was tested in a rat model.. There were 4 experimental groups.. Rat fetuses without any manipulation. Fetuses were harvested by cesarean section for examination at E21.5 (Term). SHAM GROUP: On E18.5, the hind limb of the rat fetuses were exteriorized by hysterotomy and replaced in the uterus. GASTROSCHISIS GROUP: Gastroschisis was surgically created in rat fetuses on E18.5, under a dissection microscope (16×). GASTROSCHISIS+FUROSEMIDE GROUP: After surgical creation of gastroschisis on E18.5, intraamniotic furosemide (5 mg/kg) was administered to the fetuses on E20. All fetuses were harvested on E21.5.. There was no significant difference between intestinal serosal thicknesses of the control and sham groups. The serosal thickness was significantly higher in the gastroschisis group compared to the control group. In the gastroschisis+furosemide group, the intestinal serosal thickness was found significantly decreased compared with the gastroschisis group.. Intraamniotic furosemide injection caused a substantial decrease in ID encountered in gastroschisis. The induction of fetal diuresis with intraamniotic furosemide injection seems promising as a prenatal treatment modality.

Topics: Amnion; Animals; Disease Models, Animal; Diuresis; Diuretics; Fetal Therapies; Furosemide; Gastroschisis; Injections; Intestinal Diseases; Meconium; Rats; Rats, Sprague-Dawley

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

Topics: Biopsy; Child; Child, Preschool; Chronic Disease; Constipation; Female; Humans; Infant; Intestinal Diseases; Male; Meconium; Rectum

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

Enterolithiasis (multiple calcifications of intraluminal meconium) is a rare, prenatal ultrasonographic finding. In this study, our aim was to evaluate the prenatal diagnostic features and discuss the management of the patients.. The data of two cases of prenatally diagnosed fetal enterolithiasis were collected from ultrasound scan, magnetic resonance imaging (MRI) and neonatal or postnatal autopsy records. The findings were evaluated in both prenatal and postnatal periods. Chromosomal analysis was performed in one case. An evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for via radiology, neonatal surgery and histopathology.. Malformations in two cases (both males) with partial and complete urorectal septum malformation (URSM) sequence were described. The absence of an anal opening and presence of a fistula between the urinary and gastrointestinal tract were common findings. These features were considered as primary malformations contributing to the formation of enterolithiasis. Secondary anomalies (urinary and gastrointestinal system malformations, pulmonary hypoplasia, genital and other coexisting anomalies) were evaluated.. The prenatal detection of enterolithiasis carries a poor prognosis. Most of the previously reported cases were invariably associated with major fetal malformations of the urinary and gastrointestinal tract. It is a warning sign for large bowel obstruction with or without enterourinary fistula. Therefore, adequate gastrointestinal and urologic studies must be undertaken after birth for the final diagnosis. There is a high mortality rate in the reported cases, mostly attributed to associated anomalies, and all survivors required neonatal surgery. It is important to differentiate the partial from the full URSM sequence because the prognosis in the partial URSM sequence is generally good, with long-term survival being common.

Topics: Adult; Calcinosis; Diseases in Twins; Female; Fetal Diseases; Humans; Intestinal Diseases; Intestines; Magnetic Resonance Imaging; Male; Meconium; Oligohydramnios; Pregnancy; Prenatal Diagnosis; Rectum; Ultrasonography, Prenatal; Urinary Tract

Contact with amniotic fluid causes intestinal damage in gastroschisis, and intraamniotic meconium has been shown to be responsible. Meconium has been shown to contain a significant amount of IL-8, which may be the responsible cytokine for harmful effects of meconium. Neonatal urine contains high amount of urinary trypsin inhibitor (UTI) compared with adult human urine. Urinary trypsin inhibitor has been shown to exert inhibitory effects on IL-8. Therefore, far from being destructive, presence of fetal urine in the amniotic fluid might be beneficial because human urine contains UTI. An experimental study has been performed to investigate whether presence of intraamniotic human urine (consequently UTI) besides meconium is beneficial on intestines of chick embryo with gastroschisis.. Five-day-old fertilized chick eggs were used. Gastroschisis was created through amniotic cavity without opening the allantoic cavity. Sterile urine and meconium were obtained from newborn humans. Study was conducted in 2 stages. In the first stage, gastroschisis was created, and meconium suspensions at minimal harmful meconium concentration were prepared using natural and denatured human neonatal urine and instilled into the amniotic cavity. In the second stage of study, various concentrations of UTI plus meconium suspension at minimal harmful meconium concentration was instilled into the amniotic cavity.. Serosal thickening, inflammation, and focal fibrin deposits were observed in intestines of the groups with meconium and meconium in denatured urine. Histopathologic features of intestines of the group with meconium in natural urine did not differ from the intestines of the control group. Histopathologic examination of intestines of groups with meconium and meconium plus 50 U/mL UTI showed serosal thickening, inflammation, focal fibrin, and collagen deposits. Histopathologic features of intestines of the groups with 1:400 intraamniotic meconium plus 100 and 200 U/mL UTI did not differ from the intestines of control group.. Urinary trypsin inhibitor 100 U/mL prevented the intestinal damage via inhibiting IL-8, which is contained by 1:400 concentration of meconium. Therefore, besides the existence of threshold level of meconium, the existence of UTI, which is capable of inhibiting IL-8 contained by threshold level of meconium, may be a factor in the occurrence of intestinal damage in gastroschisis.

Topics: Amniotic Fluid; Animals; Chick Embryo; Gastroschisis; Glycoproteins; Humans; Infant, Newborn; Interleukin-8; Intestinal Diseases; Meconium; Urine

Topics: Amniotic Fluid; Animals; Disease Models, Animal; Gastroschisis; Inflammation; Intestinal Diseases; Meconium; Rats

Information concerning long-term operative outcomes in patients with cystic fibrosis (CF) is relatively sparse in the operative literature.. A retrospective review of CF patients with operative conditions was performed (1972-2004) at a tertiary children's hospital to analyze outcomes including long-term morbidity and survival.. A total of 226 patients with CF presented with an operative diagnosis (113 men, 113 women). A total of 422 operations were performed in 213 patients (94%). The mean age at operation was 4.1 +/- 6.2 years (range, 1 d to 26 y) and 109 were neonates. Fifteen of 42 (36%) babies with simple meconium ileus (MI) were treated nonoperatively with hypertonic enemas, 27 of 42 and all 45 patients with complicated MI required operation, including 15 with jejunoileal atresia (17%). Seventeen of 27 (63%) patients with meconium ileus equivalent had MI as neonates; 7 of 27 (26%) required operation. Eight of 9 (89%) with fibrosing colonopathy required operation. Organ transplantation was required in 21 patients. Follow-up evaluation was possible in 204 of 213 (96%) patients. The duration of follow-up evaluation was 14.9 +/- 8.5 years (range, 2 mo to 35 y). Operative morbidity was 11% at 1 year, 2% at 2 to 4 years, 1% at 5 to 10 years, and less than 1% at more than 10 years. There were 24 deaths (11%); 22 followed CF-related pulmonary complications and included 8 of 16 (50%) children with pneumothorax.. Long-term survival in CF patients has improved significantly (89%), with many surviving into the fourth decade. MI may predispose to late complications including meconium ileus equivalent and fibrosing colonopathy. Pneumothorax in CF patients is an ominous predictor of mortality. Children with CF are living longer and are good candidates for operation, but require long-term follow-up evaluation because of ongoing exocrine dysfunction.

Topics: Abdomen; Adolescent; Adult; Bile Duct Diseases; Child; Child, Preschool; Cystic Fibrosis; Female; Humans; Ileus; Infant; Infant, Newborn; Intestinal Diseases; Intussusception; Liver Diseases; Male; Meconium; Pneumothorax; Postoperative Complications; Retrospective Studies; Survival Analysis; Thoracic Surgical Procedures; Treatment Outcome

Topics: Amniocentesis; Amniotic Fluid; beta-Endorphin; Diuresis; Diuretics; Female; Fetal Diseases; Furosemide; Gastroschisis; Humans; Intestinal Diseases; Meconium; Oligohydramnios; Pregnancy; Prognosis; Sodium Chloride; Therapeutic Irrigation

To evaluate the effect of gender, gestational age, birthweight, mode of delivery, 5'-Apgar score and maternal conditions on calprotectin concentrations in meconium.. Calprotectin was measured in 131 neonates, in the first passed meconium.. Calprotectin levels (mean +/- SD) resulted in 145.2 +/- 78.5 mg kg(-1) meconium, significantly correlated with birthweight (r = -0.333; p < 0.001), gestational age (r = -0.206; p = 0.018) and 5'-Apgar score (r = -0.243, p = 0.035). The estimated regression model was: calprotectin levels (mg kg(-1)) = 269.58-41.54 weight (kg): r = 0.383, p < 0.001. No differences were found in relation to gender, mode of delivery and maternal conditions.. Calprotectin is already present in the first passed meconium, with higher levels in preterm and low birthweight neonates, as well as in neonates with some degree of perinatal asphyxia, as indicated by the negative correlation with 5'-Apgar score. These findings are probably secondary to both the immaturity of the intestinal mucosa and its hypoxic-ischaemic damage.

Topics: Apgar Score; Birth Weight; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Intestinal Diseases; Leukocyte L1 Antigen Complex; Male; Maternal Welfare; Meconium; Predictive Value of Tests; Pregnancy; Sex Factors

Topics: Amniotic Fluid; Animals; Coproporphyrins; Gastroschisis; Intestinal Diseases; Meconium; Meningomyelocele; Rats; Spinal Cord

In gastroschisis, contact with amniotic fluid (AF) causes intestinal damage. Intraamniotic meconium has been shown to be responsible for the intestinal damage, and intestinal damage has been shown to correlate with intraamniotic meconium concentrations. Intraamniotic meconium below a threshold level does not cause intestinal damage. Intraamniotic meconium concentrations can be lowered by AF exchange. Can induction of foetal diuresis by an intraamniotic injection of furosemide be used as an alternative method for the same purpose?. Pregnant rabbits on the 23rd - 25th gestational days (normal gestation time: 31 - 33 days) were divided into two groups, the control group and the furosemide group. Initial AF samples were taken, then either 5 mg/kg furosemide or a placebo was injected into the amniotic cavity. Final AF samples were obtained 6 hours later. AF urea nitrogen, creatinine, amylase, alkaline phosphatase and bilirubin levels were determined.. There was no significant difference between the initial and final levels of AF urea nitrogen, creatinine, bilirubin, amylase, and alkaline phosphatase in the control group, while the final AF urea nitrogen and creatinine levels of the furosemide group were not significantly different from the initial levels (p > 0.05). Final AF bilirubin, amylase and alkaline phosphatase levels of the furosemide group were significantly decreased compared with initial levels (p < 0.01).. Induction of foetal diuresis with intraamniotic furosemide is effective for the removal of intestinal waste products from amniotic fluid.

Topics: Amnion; Animals; Diuretics; Female; Fetal Diseases; Furosemide; Gastroschisis; Injections; Intestinal Diseases; Meconium; Pregnancy; Rabbits; Statistics, Nonparametric

Increasing evidence of physiologic in utero defecation supports the hypothesis that bowel damage in gastroschisis may be meconium dependent. In this study, the author investigated the role of meconium on parameters of bowel damage in a fetal rat model of gastroschisis.. Pregnant rats underwent laparotomy at 18 1/2 days gestational age (GA). There were 4 experimental groups of 11 fetuses each; the G(M) group consisted of fetuses with isolated gastroschisis and was considered to have moderate meconium contamination of the amniotic fluid (MCAF); the G(L) group consisted of fetuses with gastroschisis and anal ligation, performed to prevent MCAF; the G(H) group consisted of fetuses with gastroschisis and colon perforation, performed to increase MCAF; and the Sham group consisted of sham operated controls. All fetuses were harvested by cesarean section at 21 1/2 days GA, and the fetal intestine was assessed for peel, intestinal length, intestinal weight per unit length, and histologic appearance.. The authors achieved the following fetal survival rates: G(M) group, 91% (10 of 11); G(L) group, 78% (7 of 9, the ligation was not successful in 2 fetuses); G(H) group, 82% (9 of 11). Sham group, 100% (11 of 11). Intestinal length was decreased in fetuses with gastroschisis, and this reduction was related directly to the grade of MCAF (Sham, 18.4 +/- 0.6; G(L), 11.5 +/- 0.5; G(M), 10.2 +/- 0.6; G(H), 9.1 +/- 0.6 cm; P <.01). In contrast, intestinal weight per unit length increased in fetuses with gastroschisis, and this increase was related directly to the grade of MCAF (Sham, 7.8 +/- 0.5; G(L), 9.4 +/- 0.5; G(M), 11.3 +/- 0.5; G(H), 16.9 +/- 0.7 mg/cm; P <.01). In comparison with the G(M) group, the degree of peel coverage and bowel adherence were increased markedly in the G(H) group, whereas the fetuses of the G(L) group had neither peel nor bowel adherence.. All bowel damage parameters were affected by MCAF supporting the hypothesis that bowel damage in gastroschisis is at least partially dependent on meconium exposure. Further research is required to clarify other factors that contribute to bowel damage and to identify risk factors that may allow prenatal identification of severely affected fetuses.

Topics: Amniotic Fluid; Anal Canal; Animals; Female; Fetal Diseases; Gastroschisis; Intestinal Diseases; Intestines; Ligation; Meconium; Organ Size; Rats; Rats, Wistar

Topics: Anus, Imperforate; Calculi; Esophageal Fistula; Humans; Infant, Newborn; Intestinal Diseases; Meconium; Radiography

Contact with amniotic fluid (AF) causes intestinal damage in gastroschisis, which has been shown to be caused by intraamniotic meconium. However, whether this intraamniotic meconium-induced intestinal damage is concentration dependent has not been investigated previously. The purpose of this study is to investigate the effects of intraamniotic human meconium at various concentrations on the intestines of chick embryo with gastroschisis.. Five-day-old fertilized chick eggs were used. Gastroschisis was created through the amniotic cavity without opening the allantoic cavity. Sterile meconium was obtained from newborn humans. Meconium suspensions at various concentrations were prepared using saline and instilled into the amniotic cavity.. Intraamniotic 1:200 and 1:400 meconium was found to cause intestinal damage. Meconium concentrations lower than 1:400 did not cause intestinal damage. Histopathologic examination of the intestines of the 1:200 and 1:400 meconium groups showed serosal thickening, inflammation, focal fibrin, and collagen deposits. Histopathologic features of the intestines of the 1:600 and 1:800 meconium groups did not differ from the intestines of the control group.. Intraamniotic meconium, which is responsible for intestinal damage in gastroschisis, must reach a threshold level to induce intestinal damage. J Pediatr Surg 36:1811-1815.

Topics: Amniotic Fluid; Animals; Chick Embryo; Gastroschisis; Humans; Infant, Newborn; Intestinal Diseases; Intestinal Mucosa; Intestines; Meconium

Enterolithiasis is a rare, prenatal ultrasonographic finding. Previously reported cases were invariably associated with major fetal malformations. We describe a case of fetal enterolithiasis and anhydramnios in an anatomically normal fetus who, at autopsy, showed end-stage fetal liver disease. Fetal hepatorenal syndrome is the most probable cause of this in utero sonographic combination.

Topics: Adult; Calcinosis; Female; Fetal Diseases; Gestational Age; Hepatorenal Syndrome; Humans; Intestinal Diseases; Male; Meconium; Oligohydramnios; Pregnancy; Ultrasonography, Prenatal

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

A patient with acute hydramnios and advanced preterm labor at 34 weeks was seen after gastroschisis had been diagnosed by second-trimester fetal ultrasonography. The fetus also had meconium peritonitis and acute ascites. The distended abdomen did not decompress spontaneously during the second stage of labor. Severe abdominal dystocia was resolved with the Zavanelli maneuver (cephalic replacement) and cesarean delivery. This is the first reported use of the Zavanelli maneuver for abdominal dystocia.

Topics: Abdominal Muscles; Adolescent; Ascites; Cesarean Section; Dystocia; Female; Fetal Diseases; Fetus; Humans; Intestinal Diseases; Meconium; Obstetrics; Peritonitis; Pregnancy; Ultrasonography, Prenatal

We studied the intestinal flora of 23 newborns, whose meconium had yielded a pure culture of Pseudomonas aeruginosa on blood agar medium. Twelve infants had a single serotype of P. aeruginosa in their meconium, 10 had a second serotype and the last infant was carrying three distinct ones. The maximum levels of P. aeruginosa observed during the first week of life were variable among the infants: 1 x 10(3) to 1 x 10(10) CFU/g of stools. The levels diminished progressively afterwards, and after 1 year of age only 1 of the 13 infants examined remained a carrier of P. aeruginosa. In 11 infants a second or a third serotype occurred during the course of the study. The serotypes that appeared secondarily always disappeared before the initial ones. Antibiotics: ampicillin + gentamicin or cefotaxime + netilmicin and colistin which were given to 8 infants had no clear effect on P. aeruginosa levels. Four infants had delayed colonization by Escherichia coli of greater than or equal to 10 days. All 4 had high levels of P. aeruginosa: 1 x 10(7) to 1 x 10(10) CFU/g stool, and antibiotic therapy, rendering it impossible to assess which was the cause of this delay. This colonization by P. aeruginosa did not lead to any clinical trouble.

Topics: Cefotaxime; Colistin; Drug Therapy, Combination; Escherichia coli; Feces; Female; Gentamicins; Humans; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Intestinal Diseases; Male; Meconium; Netilmicin; Pseudomonas aeruginosa; Pseudomonas Infections; Serotyping; Ticarcillin; Time Factors

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

Topics: Cysts; Humans; Infant, Newborn; Intestinal Diseases; Male; Meconium; Peritonitis; Radiography

Out of 813 laparotomies performed for surgical problems of small bowel in infants and children, resections were necessary in 327 patients. A primary enterostomy was done in 75 cases with subsequent anastomosis. The different surgical problems, the operative findings, the various procedures adopted and the results thereof are discussed here. The greatest danger was seen to arise from the ischaemia of the bowel and from peritonitis. In doubtful conditions of small bowel two-stage operation seems advisable.

Topics: Child; Child, Preschool; Enterocolitis, Pseudomembranous; Hernia; Humans; Ileostomy; Infant; Infant, Newborn; Intestinal Diseases; Intestinal Obstruction; Meconium; Prognosis; Stomach

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: Cysts; Humans; Infant, Newborn; Intestinal Diseases; Male; Meconium; Peritonitis

Review of the newborn nursery notes of 87 infants who had cystic fibrosis without meconium ileus (MI) indicated that 12 of them had clinical features consistent with the meconium plug syndrome (MPS). This high incidence of meconium abnormalities suggests that MI and the MPS probably represent different gradations of the same underlying pathologic abnormality. The findings further suggest that a quantitative pilocarpine iontophoresis sweat test be performed in every newborn infant with any type of meconium abnormality, including the spontaneous passage of meconium plugs.

Topics: Child, Preschool; Cystic Fibrosis; Humans; Infant; Infant, Newborn; Intestinal Diseases; Intestinal Obstruction; Meconium; Pilocarpine; Sweat; Syndrome

Topics: Calculi; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Diseases; Male; Meconium

Gastrografin (methylglucamine diatrizoate) enemas were carried out in 2 newborn infants with meconium ileus. Evacuation was slow and incomplete. Both patients died within 72 hours following enemas from bowel necrosis, perforation and peritonitis. Although it is not possible to implicate Gastrografin directly as the cause, it is suggested that it may have contributed substantially to bowel necrosis. Recent experimental evidence of colonic inflammation and occasionally necrosis caused by Gastrografin lends support to this hypothesis. Caution should be exercised to prevent not only the systemic osmotic effects of Gastrografin, but also potential local injury to the bowel, especially when underlying disease interferes with intestinal viability.

Topics: Diatrizoate; Diatrizoate Meglumine; Enema; Female; Humans; Infant, Newborn; Intestinal Diseases; Intestinal Obstruction; Meconium; Necrosis; Radiography

Intestinal surgery in the foal is seldom necessary but some conditions in which it is essential are well recognized. The foal is a good surgical subject but success depends mainly on operating promptly before irreversible degenerative changes take place. Exploratory laparatomy is recommended whenever mechanical obstruction is suspected. Indications fall broadly into two main categories: 1. Cases arising from congenital defects. These form a miscellaneous group and present considerable difficulties in diagnosis and effective treatment. 2. Cases related to acute onset of obstruction, mainly due to volvulus or torsion. By far the most important condition in this category is volvulus of the ileum close to the ileocaecal valve. Aetiological factors are discussed, and the value of resection of affected small intestine and creation of a new jejuno-caecal opening is indicated. It is suggested that with improvement of such techniques it will be possible to save a higher proportion of foals suffering from mechanical intestinal obstruction.

Topics: Abdomen; Anesthesia; Animals; Cecal Diseases; Duodenal Obstruction; Hernia; Herniorrhaphy; Horse Diseases; Horses; Intestinal Diseases; Intestinal Obstruction; Intestine, Large; Intestines; Intussusception; Meconium; Postoperative Care; Pyloric Stenosis; Torsion Abnormality

Five cases are reported and reference is made to 3 previous similar cases of calcified intraluminal meconium in newborn males with "imperforate anus." A rectourinary fistula was found in most of the patients; none of the cases had meconium peritonitis. The calcifications may develop in areas of prolonged stasis; the possible added role of the mixture of urine and meconium in utero is raised.

Topics: Abnormalities, Multiple; Anus, Imperforate; Calculi; Humans; Infant, Newborn; Intestinal Diseases; Male; Meconium; Radiography; Rectal Fistula; Urinary Fistula

Topics: Child, Preschool; Cysts; Female; Fetal Diseases; Humans; Ileum; Infant, Newborn; Intestinal Diseases; Intestinal Perforation; Meconium; Pregnancy; Radiography, Abdominal

Topics: Colon; Female; Ganglia; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Laparotomy; Meconium; Thrombophlebitis; Vena Cava, Inferior

Topics: Barium; Diagnosis, Differential; Enema; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Meconium; Megacolon; Radiography

Topics: Duodenal Diseases; Duodenal Ulcer; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Intussusception; Laparotomy; Meckel Diverticulum; Meconium; Methods; Peritonitis; Suture Techniques; Time Factors

Topics: Animals; Dogs; Female; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Absorption; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Jejunum; Male; Meconium; Postoperative Complications; Rabbits; Rats; Swine

Topics: Adrenal Insufficiency; Congenital Abnormalities; Cysts; Hernia, Umbilical; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Intussusception; Meconium; Megacolon; Mesenteric Vascular Occlusion; Pathology; Peritonitis; Surgical Procedures, Operative

Topics: Calcification, Physiologic; Child; Disease; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Diseases; Intestines; Meconium

Topics: Child; Cystic Fibrosis; Disease; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Diseases; Intestinal Obstruction; Intestines; Meconium; Pancreas; Pancreatic Diseases