morphine and Intestinal-Pseudo-Obstruction

Cystic fibrosis (CF) is a multisystem disorder intrinsically associated with inflammation of mucosal surfaces. Because inflammation can result in enteric neuromuscular dysfunction we hypothesized that terminal ileitis in patients with CF may predispose to distal ileal obstruction syndrome (DIOS).. Full-thickness terminal ileal tissues from 6 children with CF and severe DIOS, 6 infants with complicated meconium ileus (MI), and 6 children with non-CF intestinal atresia were studied.. Lymphocyte-predominant mucosal and transmural ileal inflammation was present in 6 of 6 patients with DIOS. Lymphocytic ganglionitis was present in 4 of 6 although numbers of myenteric neurons were not decreased (5/5). Myocyte proteins were preserved (6/6). Mild submucosal fibrosis was common in DIOS (5/6) and transformation of submucosal fibroblasts to a myofibroblastic phenotype was noted in 4 of 6. Inflammatory changes were distinct from those described in fibrosing colonopathy. Antroduodenal manometry in an individual who had experienced MI/DIOS was consistent with a neuropathic pseudo-obstructive process. Submucosal or transmural lymphocyte predominant inflammation was also present in 6 of 6 infants with complicated MI, which, when coupled with submucosal myofibroblast proliferation (5/6), appeared highly predictive of CF rather than non-CF atresia. Histological findings at birth were similar, although milder, than those seen in DIOS, suggesting that these changes are a primary abnormality in CF.. Submucosal or transmural inflammation of the ileum is common in newborns with CF and MI and older children with DIOS. Severe recurrent DIOS should be investigated with seromuscular and mucosal biopsy of the ileum to seek a transmural ileitis potentially amenable to anti-inflammatory therapies.

Topics: Adolescent; Child; Child, Preschool; Crohn Disease; Cystic Fibrosis; Duodenum; Female; Fibroblasts; Ganglion Cysts; Humans; Ileum; Ileus; Infant; Inflammation; Intestinal Atresia; Intestinal Mucosa; Intestinal Pseudo-Obstruction; Lymphocytes; Male; Manometry; Meconium; Muscle Cells; Myenteric Plexus; Retrospective Studies

We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction (27.8%) followed by duodenal atresia (13.9%) and colonic atresia and meconium ileus (11.1% each). There were 8 deaths following surgery (22% mortality rate), the main causes being aspiration pneumonia, septicaemia and hypothermia.

Topics: Age Distribution; Anus, Imperforate; Cause of Death; Colon; Duodenum; Female; Hospital Mortality; Hospitals, General; Humans; Infant Mortality; Infant, Newborn; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Iraq; Male; Meconium; Retrospective Studies; Sex Distribution

Cystic fibrosis is most often the underlying cause of meconium ileus. We describe the diagnosis and treatment of a patient with chronic intestinal pseudo-obstruction, and not with cystic fibrosis, whose initial manifestation was meconium ileus.

Topics: Chronic Disease; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Male; Meconium

The suspicion of prenatal meconium ileus syndrome was raised in a pregnancy in a family with no history of cystic fibrosis because of significantly higher maternal serum alpha-fetoprotein in the 16th and 19th week of gestation, dispersed areas with increased echogenity in the fetal abdomen, slight fetal ascites in the 24th-25th weeks of gestation, decreased amniotic fluid gamma-glutamyltranspeptidase (GGT) activity and alpha-fetoprotein level in the 25th-26th weeks, and normal 46,XY karotype of the fetus. The detection of a homozygous deltaF508 cystic fibrosis transmembrane regulator (CFTR) gene mutation, by means of PCR from a small amount of white blood cells and urine sediment cells, substantiated the diagnosis of cystic fibrosis in a prematurely delivered boy in the 28th week of gestation. The repeated sweat test was unsuccessful. The autopsy examination confirmed the diagnosis of cystic fibrosis. Fetal meconium ileus syndrome was complicated by peritonitis and by formation of a meconium pseudocyst. Direct PCR typing improves postnatal diagnostic possibilities in the early neonatal period in prematurely delivered babies when the sweat test is difficult to perform.

Topics: alpha-Fetoproteins; Chromosome Deletion; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Fetal Diseases; Genetic Linkage; Genetic Markers; Humans; Infant, Newborn; Infant, Premature; Intestinal Pseudo-Obstruction; Male; Meconium; Membrane Proteins; Mutation; Polymerase Chain Reaction; Polymorphism, Genetic

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: Congenital Abnormalities; Cystic Fibrosis; Diagnosis; Female; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Meconium; Microbiology; Pathology; Polyhydramnios; Postoperative Complications; Pregnancy; Prognosis; Radiography; Statistics as Topic; Surgical Procedures, Operative

Two of 15 children who survived neonatal meconium ileus had "meconium ileus equivalent." They were treated with hydration, pancreatic enzyme therapy and antibiotics. One of these children died from pulmonary disease at the time of the bowel obstruction. The survival rate of infants with meconium ileus is steadily improving because of prompt operative intervention, better preoperative and postoperative care and long-term treatment with enzyme supplements and antibiotics. Late intestinal obstruction due to adhesive bands, volvulus, intussusception or "meconium ileus equivalent" may occur in children previously treated for meconium ileus of infancy. The omission of pancreatic enzyme supplementation and the occurrence of respiratory infections are frequently associated with "meconium ileus equivalent."In this series of patients four of the infants treated surgically for neonatal meconium ileus died in the early postoperative period.

Topics: Anti-Bacterial Agents; Child; Cystic Fibrosis; Fetal Diseases; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Intestinal Volvulus; Intussusception; Male; Meconium; Pancreas; Peritoneal Diseases; Postoperative Care; Respiratory Tract Infections; Surgical Procedures, Operative; Survival Rate

Topics: Acetylcysteine; Child; Cysteine; Cystic Fibrosis; Diagnosis; Humans; Ileus; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Intussusception; Meconium; Pancreatic Extracts; Rectal Prolapse; Surgical Procedures, Operative

Topics: Child; Cystic Fibrosis; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Meconium

Topics: Child; Cystic Fibrosis; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Meconium

Topics: Cystic Fibrosis; Humans; Ileus; Infant, Newborn; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Meconium

Topics: Cystic Fibrosis; Humans; Ileus; Infant, Newborn; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Meconium

Topics: Cystic Fibrosis; Humans; Ileus; Infant, Newborn; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Intestines; Meconium