morphine and Postoperative-Complications

Topics: Cesarean Section; Combined Modality Therapy; Embolism, Amniotic Fluid; Enterobacteriaceae Infections; Epilepsy, Generalized; Female; Hemoperitoneum; Hemostasis, Surgical; Humans; Hysterectomy; Meconium; Morganella morganii; Multiple Organ Failure; Postoperative Complications; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy; Shock; Shock, Septic; Splenectomy; Young Adult

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

Topics: Amnion; Amniotic Fluid; Color; Endoscopy; Female; Fetal Diseases; Humans; Hypoxia; Meconium; Methods; Postoperative Complications; Pregnancy

Prophylactic cefazolin was evaluated in high-risk obstetric patients who had invasive fetal monitoring and subsequent cesarean section. A three-dose regimen of either cefazolin or placebo was administered randomly in a double-blind manner to 93 patients, 48 receiving cefazolin and 45 placebo, with the first dose given when the cord was clamped. In the placebo group, 51% of the patients were treated for endomyometritis compared to 29% in the cefazolin group. The incidence of urinary tract and wound infections was similar in the 2 groups. One patient in the active drug group was diagnosed as having septic pelvic thrombophlebitis and received multiple antibiotics and heparin before she recovered. One patient in the placebo group required triple antibiotic therapy. Operation to control infection was not required in any patients and there were no maternal deaths. The cefazolin patients had fewer degree-hours of morbidity as calculated by the quantitative fever index (P less than 0.002). The perioperative use of cefazolin was efficacious in reducing the incidence of endomyometritis, but did not prevent serious postoperative pelvic infection.

Topics: Adolescent; Adult; Amniotic Fluid; Bacterial Infections; Cefazolin; Cephalosporins; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Extraembryonic Membranes; Female; Fetal Monitoring; Humans; Labor, Obstetric; Meconium; Placebos; Postoperative Complications; Pregnancy; Risk; Surgical Wound Infection; Time Factors; Urinary Tract Infections

To identify the fetal and neonatal imaging characteristics of meconium peritonitis (MP) and their clinical outcome. We also studied the role of prenatal ultrasound (US) in antenatal diagnosis and its use in predicting the need for surgical intervention postnatally.. We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014.. Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range 19-31). Fetal ascites (93.3%) was the most common prenatal US finding. Of the 18 infants, 12 (66.7%) required surgical intervention. The overall survival rate was 94.4%. All infants with a prenatal US scan showing meconium pseudocyst or bowel dilatation required surgical intervention postnatally.. A combination of ascites, intraperitoneal calcification, and echogenic bowel on fetal US raises a high suspicion of MP. Surgical intervention is indicated in the presence of meconium pseudocyst on fetal or postnatal US scan. Antenatal US has high specificity (100%) but low sensitivity (22.2%) in detecting meconium pseudocyst. A favorable outcome can be expected with early antenatal diagnosis and timely surgical intervention in a tertiary hospital.

Topics: Ascites; Cohort Studies; Combined Modality Therapy; Digestive System Abnormalities; Female; Follow-Up Studies; Gestational Age; Humans; Incidence; Infant, Newborn; Intestinal Perforation; Intestine, Small; Male; Meconium; Peritonitis; Postoperative Complications; Pregnancy; Prognosis; Retrospective Studies; Singapore; Survival Analysis; Ultrasonography, Prenatal

Topics: Adult; Aged; Cesarean Section; Female; Follow-Up Studies; Granuloma; Humans; Meconium; Middle Aged; Peritonitis; Pleural Effusion; Postoperative Complications

Enterostomy formation is a common outcome in emergency neonatal laparotomy. No consensus exists regarding optimal stoma site. This study aims to identify incidence of complications and closure details related to position of stomas.. This study is a retrospective case note review of emergency neonatal enterostomy formation over 11 years at a single institution. Patients were separated into two groups: stomas created through the laparotomy wound and stomas created through a separate incision. Demographic details, complications and closure details were ascertained. Differences between groups were analysed (Mann-Whitney test for continuous variables, Chi-squared test or Fisher's exact test for categorical variables).. One hundred and thirteen stoma formations were examined in 106 patients (71 within laparotomy wound, 42 through a separate incision). Age, gestation, weight, wound-related and stoma-related complications were not significantly different between the groups. A trend towards a higher rate of full laparotomy at closure with stomas through the wound (p = 0.09) was seen. If stomas were sited adjacently, there was no difference in avoidance of full laparotomy at closure (p = 0.97).. Stomas sited adjacently within the laparotomy wound are not related to increased complications and offer the same advantage of circumexcision at closure as stomas sited through a separate wound, without an additional abdominal wound.

Topics: Biliary Atresia; Emergencies; Enterocolitis, Necrotizing; Enterostomy; Hirschsprung Disease; Humans; Ileus; Infant, Newborn; Laparotomy; Meconium; Postoperative Complications; Retrospective Studies

Newborn surgery for meconium peritonitis (MP) is sometimes very difficult owing to severe adhesions and bleeding. The aim of this study was to reveal the benefit of primary anastomosis (PA) for MP by comparing PA with multistep operations (MO).. We retrospectively reviewed 38 patients with MP who underwent surgery in our institution from 1983 to 2009. From 1983 to 2000, we essentially used MO. After 2001, we used PA with the exception of 1 patient. We performed MO on 20 patients (group A) and PA on 18 patients (group B).. Mortality was 4 in 20 in group A and 1 in 18 in group B. Three patients in group A and 2 in group B required reoperation because of complications. After 2001, 14 of 16 patients underwent PA. Of the 2 patients for whom PA could not be performed, one was postresuscitation from cardiopulmonary arrest and the other was an extremely low-birth-weight infant. The only mortality among the patients who underwent PA occurred in a very low-birth-weight infant who died from intraoperative hepatic hemorrhage.. PA can be performed for almost all patients with MP except for extremely low-birth-weight infants.

Topics: Anastomosis, Surgical; Contraindications; Cysts; Disease Management; Drainage; Humans; Ileostomy; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Atresia; Intestinal Perforation; Intestinal Volvulus; Intussusception; Jejunostomy; Meconium; Peritonitis; Postoperative Complications; Reoperation; Retrospective Studies; Ultrasonography, Prenatal

Topics: Amniotic Fluid; Female; Fetal Diseases; Fetoscopy; Humans; Meconium; Postoperative Complications; Pregnancy; Spinal Dysraphism

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

Two newborn girls presented with congenital small-bowel atresia; in one case a high intestinal obstruction had been demonstrated by prenatal echography, while in the other case there were feeding problems and a failure to produce meconium. In both infants, the postoperative period was complicated by feeding problems, malabsorption and insufficient growth. Cystic fibrosis (CF) was then diagnosed in both patients. After modification of the diet, both showed rapid growth to a normal weight. The prevalence of CF in children with congenital small-bowel atresia is 6-13%, which is considerably higher than in a normal population. There is still no good explanation for this finding, but it is likely that CF contributes to the development of small-bowel atresia. In view of the high prevalence of CF in children with small-bowel atresia, children with congenital small-bowel atresia should be examined for CF.

Topics: Cystic Fibrosis; Female; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestine, Small; Meconium; Postoperative Complications; Treatment Outcome

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

It is unclear whether children with cystic fibrosis (CF) who present with neonatal meconium ileus have a different long-term outcome from those presenting later in childhood with pulmonary complications or failure to thrive. We examined a cohort of patients with meconium ileus, and compared their long-term outcome with children who had CF without meconium ileus and neonates who had meconium obstruction without CF (meconium plug syndrome).. Comparative study using retrospective and follow-up interview data.. Group 1 consisted of 35 surviving CF patients who presented with meconium ileus between 1966 and 1992. Two control groups were also studied: 35 age- and sex-matched CF patients without meconium ileus (group 2), and 12 infants presenting with meconium plug syndrome during the same time period (group 3).. Pulmonary, gastrointestinal, nutritional, and functional status were reviewed, and surgical complications were recorded.. Mean follow-up was 12.6 +/- 6, 12.6 +/- 6, and 9. 3 +/- 4 years in groups 1, 2, and 3, respectively. Patients without CF (group 3) demonstrated better growth and functional status, and had a lower incidence of pulmonary and gastrointestinal problems. Although the presence of meconium ileus among CF patients was associated with an earlier diagnosis, there were no significant differences between groups 1 and 2 with respect to hepatobiliary, nutritional, functional, or respiratory status. Meconium ileus was associated with a higher risk of meconium ileus equivalent (20% vs 6%), although this difference was not statistically significant. Long-term surgical complications (adhesive small bowel obstruction and blind loop syndrome) were seen in 27% of children with meconium ileus; there were no long-term surgical complications in groups 2 or 3, because these infants did not have any neonatal surgical procedures. Children presenting with complicated meconium ileus had a higher rate of long-term surgical complications than those with uncomplicated meconium ileus (36% vs 17%), and those managed with resection or enterostomy had more complications than those treated by enterotomy and lavage (33% vs 0%).. Long-term outcome is similar in CF patients who present with meconium ileus and those who do not, except for a slightly higher incidence of meconium ileus equivalent, and a significantly higher rate of surgical complications. The risk of surgical complications is highest in those presenting with complicated meconium ileus and those undergoing resection or enterostomy. Patients with meconium obstruction who do not have CF have an excellent long-term prognosis. This information will be useful in counseling the families of infants presenting with neonatal meconium obstruction.

Topics: Cystic Fibrosis; Female; Follow-Up Studies; Humans; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Postoperative Complications; Prognosis; Retrospective Studies

Meconium ileus (MI) affects 15% of neonates with cystic fibrosis (CF). The authors reviewed the management and outcome of 51 neonates presenting to a single institution between 1976 and 1995 with MI secondary to CF. Clinical presentation included abdominal distension (96%), bilious vomiting (49%), and delayed passage of meconium (36%). A family history of CF was present in 4 cases (8%). Twenty-three neonates presented with MI and evidence of volvulus, atresia, or perforation (complicated MI). Of these, 16 underwent stoma formation, 1 appendicectomy, and 6 resection with primary anastomosis. Twenty-eight neonates presented with uncomplicated MI. Of these, 11 were managed non-operatively by Gastrografin enema (10) or enteral N-acetylcysteine (1). The remainder required stoma formation (15) or bowel resection with primary anastomosis (2). Early postoperative complications occurred in 2 neonates (4%). In this hospital the 1-year survival for this condition has increased from 49% (1953-1970) to 98% (1976-1995) irrespective of the surgical procedure performed or the presence of volvulus, atresia, or perforation. In our experience, bowel resection with primary anastomosis is as safe as stoma formation and is associated with a reduced length of initial hospital stay.

Topics: Anastomosis, Surgical; Cystic Fibrosis; Enterostomy; Female; Follow-Up Studies; Humans; Incidence; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Intraoperative Complications; Laparotomy; London; Male; Meconium; Postoperative Complications; Retrospective Studies; Survival Rate

Fifteen cases of meconium ileus (MI) were treated between 1986 and 1995; 7 responded to conservative treatment. Eight were operated upon, and comprise the study group. Six of the operated babies had no complications; 1 had meconium peritonitis with a pseudocyst and small-bowel atresia, and 1 had a volvulus of a small-bowel segment with necrosis. In all 8 cases a T-tube (TT) was left via an enterotomy; in the complicated cases the enterotomy was pre-anastomotic. The obstruction was relieved in all the babies, without any stoma or bowel resection in the uncomplicated cases. Two complications occurred: 1 patient died of respiratory failure 1 month following surgery and another required a relaparotomy for lysis of adhesions. We conclude that TT ileostomy is an effective and safe procedure for uncomplicated cases of MI that do not respond to conservative therapy, as well as for complicated cases that need an anastomosis.

Topics: Cause of Death; Female; Follow-Up Studies; Humans; Ileostomy; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Male; Meconium; Peritonitis; Postoperative Complications; Survival Rate

Kawasaki syndrome appeared after operation for meconium ileus equivalent in a 4-year-old child with cystic fibrosis. The course and management are described.

Topics: Child, Preschool; Cystic Fibrosis; Female; Humans; Intestinal Obstruction; Meconium; Mucocutaneous Lymph Node Syndrome; Postoperative Complications

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

A child with cystic fibrosis developed the meconium ileus equivalent in the postappendectomy period. This problem has not been emphasized in patients with cystic fibrosis. Operative evacuation only partially relieved the obstruction. Transient upper gastrointestinal bleeding fortuitously produced beneficial effect, which completely resolved the persisting ileus.

Topics: Appendectomy; Appendicitis; Child, Preschool; Cystic Fibrosis; Feces; Humans; Intestinal Obstruction; Male; Meconium; Peritonitis; Postoperative Complications

Intestinal obstruction and necrotizing enterocolitis are two of the most common surgical emergencies of the gastrointestinal tract. This article reviews the signs and symptoms of these conditions and presents guidelines for their management.

Topics: Colon; Diagnosis, Differential; Duodenal Obstruction; Emergencies; Enterocolitis, Pseudomembranous; Fluid Therapy; Humans; Ileum; Infant, Newborn; Infant, Premature, Diseases; Intestinal Atresia; Intestinal Obstruction; Jejunum; Meconium; Postoperative Complications

Meconium peritonitis being a rare anomaly, it is difficult to find the factors that determine the prognosis. In spite of the high mortality, this aspect has hardly ever been studied. A retrospective study of 69 patients from the Netherlands over a 15 year period, revealed that a patient with pneumoperitoneum and a generalized type of meconium peritonitis has a relatively favourable prognosis. Despite a more optimistic outlook expressed in recent publications, an overview of the world literature involving 1084 patients shows that the mortality for this disease has not dropped in the past 15 years and still amounts to 55%.

Topics: Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Postoperative Complications; Pregnancy; Prognosis; Retrospective Studies

Topics: Cystic Fibrosis; Enema; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Postoperative Complications; Pregnancy

Topics: Germany, West; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Postoperative Complications

Topics: Age Factors; Birth Weight; Cystic Fibrosis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Postoperative Complications; Pyloric Stenosis; Time Factors

Topics: Catheterization; Female; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Jejunum; Meconium; Postoperative Complications

Topics: Female; Follow-Up Studies; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Methods; Postoperative Complications; Radiography

Topics: Cystic Fibrosis; Diatrizoate; Enema; Female; Humans; Infant, Newborn; Intestinal Obstruction; Meconium; Methods; Postoperative Complications; Radiography; Respiratory Tract Diseases

Topics: Anti-Bacterial Agents; Catheterization; Cystic Fibrosis; Germany, East; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium; Pneumonia; Postoperative Complications; Staphylococcal Infections

Topics: Cystic Fibrosis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium; Methods; Peritonitis; Postoperative Complications

Topics: Animals; Dogs; Gas Gangrene; Humans; Hydrogen Peroxide; Infant, Newborn; Infusions, Parenteral; Intestinal Obstruction; Male; Meconium; Mesenteric Vascular Occlusion; Postoperative Complications

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: 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

Topics: Adolescent; Child; Cystic Fibrosis; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium; Pathology; Postoperative Complications; Prognosis; Surgical Procedures, Operative

Topics: Adolescent; Cystic Fibrosis; Humans; Ileus; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Secretions; Meconium; Pancreatic Extracts; Pathology; Postoperative Complications; Surgical Procedures, Operative; Tetracycline