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Changing Patterns of Treatment and Survival in Neonates With Meconium Ileus

Changing Patterns of Treatment and Survival in Neonates With Meconium Ileus Abstract • 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. (Arch Surg. 1989;142:837-840 References 1. Wilmott RW, Tyson SL, Dinwiddie R, Matthew DJ. Survival rates in cystic fibrosis . Arch Dis Child . 1983;38:835-836.Crossref 2. Lloyd DA. Meconium ileus . In: Welch KJ, Randolf JG, Ravitch MM, O'Neill JA Jr, Rowe MI, eds. Pediatric Surgery . Chicago, Ill: Year Book Medical Publishers Inc; 1986:849-858. 3. Park RW, Grand RJ. Gastrointestinal manifestations of cystic fibrosis: a review . Gastroenterology . 1981;81:1143-1161. 4. Donnison AB, Shwachman H, Gross RE. Review of 164 children with meconium ileus seen at the Children's Hospital Medical Center, Boston . Pediatrics . 1966;37:833-850. 5. Landsteiner K. Darmverschluss durch eingedictes Meconium Pankreatitis . Zentralbl Allg Pathol . 1905;16:903-907. 6. Kornblith BA, Otani S. Meconium ileus associated with stenosis of the pancreatic ducts . Am J Pathol . 1929;5:249-262. 7. Hurwitt ES, Arnheim EE. Meconium ileus associated with stenosis of the pancreatic ducts . AJDC . 1942;64:443-454. 8. Fanconi G, Uehlinger E, Knauer C. Das Coeliakiesyndrom bei angeborener zystischer Pancreasfibromatose und Bronchiektasien . Wien Med Wochenschr . 1936;86:753-756. 9. Andersen DH. Cystic fibrosis of the pancreas and its relation to celiac disease . AJDC . 1938;56:344-399. 10. Farber SJ. The relation of pancreatic achylia to meconium ileus . J Pediatr . 1944;24:387-392.Crossref 11. Thomaidis TS, Arey JB. The intestinal lesions in cystic fibrosis of the pancreas . J Pediatr . 1963;63:444-453.Crossref 12. Fleischer AC, Davis RJ, Campbell L. Sonographic detection of a meconium-containing mass in a fetus: a case report . JCU . 1983;11:103. 13. Goldstein RB, Filly RA, Callen PW. Sonographic diagnosis of meconium ileus in utero . J Ultrasound Med . 1987;6:663-666. 14. Kalayoglu M, Sieber WK, Rodnan JB, Kiesewetter WB. Meconium ileus: a critical review of treatment and eventual prognosis . J Pediatr Surg . 1971;6:290-300.Crossref 15. West DK, Touloukian RJ. Meconium pseudocyst presenting as a buttock mass . J Pediatr Surg . 1988;23:864-865.Crossref 16. Rosenstein BJ. Cystic fibrosis presenting with the meconium plug syndrome . AJDC . 1978;132:167-169. 17. Olsen MM, Luck SR, Lloyd-Still J, Raffensperger JG. The spectrum of meconium disease in infancy . J Pediatr Surg . 1982;17:479-481.Crossref 18. Rescorla FJ, Grosfeld JL. Intestinal atresia and stenosis: analysis of survival in 120 cases . Surgery . 1985;98:668-676. 19. Neuhauser EBD. Roentgen changes associated with pancreatic insufficiency in early life . Radiology . 1946;46:319-328.Crossref 20. Hiatt RB, Wilson PE. Celiac syndrome: therapy of meconium ileus: report of eight cases with a review of the literature . Surg Gynecol Obstet . 1948;87:317-327. 21. Gross RE. The Surgery of Infancy and Childhood . Philadelphia, Pa: WB Saunders Co; 1953:175-191. 22. Olim CB, Ciuti A. Meconium ileus: a new method of relieving obstruction . Ann Surg . 1954;140:736-740.Crossref 23. Bishop HC, Koop CE. Management of meconium ileus: resection, Rouxen-Y anastomosis and ileostomy irrigation with pancreatic enzymes . Ann Surg . 1957;145:410-414.Crossref 24. Santulli TV, Blanc WA. Congenital atresia of the intestine: pathogenesis and treatment . Ann Surg . 1961;154:939-948. 25. Meeker IA Jr, Kincannon WN. Acetylcysteine used to liquify inspissated meconium causing intestinal obstruction in the newborn . Surgery . 1964;56:419-425. 26. Holsclaw DS, Eckstein HB, Nixon HH. Meconium ileus . AJDC . 1965;109:101-113. 27. Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report . J Pediatr Surg . 1969;4:190-197.Crossref 28. Frech RS, McAlister WH, Ternberg J, Strominger D. Meconium ileus relieved by 40 per cent water-soluble contrast enemas . Radiology . 1970;94:341-342.Crossref 29. Noblett H. Meconium ileus . In: Ravitch MM, Welch KJ, Benson CD, Aberdeen E, Randolph JG. eds. Pediatric Surgery . 3rd ed. Chicago, Ill: Year Book Medical Publishers Inc; 1979:943-952. 30. WaggetJ, Bishop HC, Koop CE. Experience with Gastrografin enema in the treatment of meconium ileus . J Pediatr Surg . 1970;5:649-654.Crossref 31. Lillie JG, Chrispin AR. Investigation and management of neonatal obstruction by Gastrografin enema . Ann Radiol . 1972;15:237. 32. Mabogunje OA, Wang CI, Mahour GH. Improved survival of neonates with meconium ileus . Arch Surg . 1982;117:37-40.Crossref 33. Nguyen LT, Youssef S, Guttman FM, Laberge JM, Albert D, Doody D. Meconium ileus: is a stoma necessary? J Pediatr Surg . 1986;21:766-768.Crossref 34. Caniano DA, Beaver BL. Meconium ileus: a fifteen year experience with forty-two neonates . Surgery . 1987;102:699-703. 35. Ein SH, Shandling B, Reilly BJ, Stephens CA. Bowel perforation with nonoperative treatment of meconium ileus . J Pediatr Surg . 1987;22:146-147.Crossref 36. Maneksha FR, Betta J, Zawin M, Poppers PJ. Intraoperative hypoxia and hypotension caused by Gastrografin-induced hypovolemia . Anesthesiology . 1984;61:454-456.Crossref 37. Grantmyre EB, Butler GJ, Gillis DA. Necrotizing enterocolitis after Renografin 76 treatment of meconium ileus . Am J Radiol . 1981;136:990-991. 38. Swenson O. Pediatric Surgery . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1962. 39. O'Neill JA, Grosfeld JL, Boles ET, Clatworthy NW Jr. Surgical treatment of meconium ileus . Am J Surg . 1970;119:99-105.Crossref 40. Harberg FJ, Senekjian EK, Pokorny WJ. Treatment of uncomplicated meconium ileus via T-tube ileostomy . J Pediatr Surg . 1981;16:61-63.Crossref 41. Venugopal S, Shandling B. Meconium ileus: laparotomy without resection, anastomosis, or enterostomy . J Pediatr Surg . 1979;14:715-718.Crossref 42. Grosfeld JL, Ballantine TVN, Shoemaker R. Operative management of intestinal atresia and stenosis based on pathologic findings . J Pediatr Surg . 1979;14:368-375.Crossref 43. MacDonald JA, Trusler GA. Meconium ileus: an eleven year review at the Hospital for Sick Children, Toronto, Canada . Can Med Assoc J . 1960;83:881-885. 44. Williams MPL. Chimney ileostomy: is closure a simple procedure? Presented at the British Association of Paediatric Surgeons 35th Annual International Congress; September 22, 1988; Athens, Greece. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Changing Patterns of Treatment and Survival in Neonates With Meconium Ileus

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410070095019
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Abstract

Abstract • 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. (Arch Surg. 1989;142:837-840 References 1. Wilmott RW, Tyson SL, Dinwiddie R, Matthew DJ. Survival rates in cystic fibrosis . Arch Dis Child . 1983;38:835-836.Crossref 2. Lloyd DA. Meconium ileus . In: Welch KJ, Randolf JG, Ravitch MM, O'Neill JA Jr, Rowe MI, eds. Pediatric Surgery . Chicago, Ill: Year Book Medical Publishers Inc; 1986:849-858. 3. Park RW, Grand RJ. Gastrointestinal manifestations of cystic fibrosis: a review . Gastroenterology . 1981;81:1143-1161. 4. Donnison AB, Shwachman H, Gross RE. Review of 164 children with meconium ileus seen at the Children's Hospital Medical Center, Boston . Pediatrics . 1966;37:833-850. 5. Landsteiner K. Darmverschluss durch eingedictes Meconium Pankreatitis . Zentralbl Allg Pathol . 1905;16:903-907. 6. Kornblith BA, Otani S. Meconium ileus associated with stenosis of the pancreatic ducts . Am J Pathol . 1929;5:249-262. 7. Hurwitt ES, Arnheim EE. Meconium ileus associated with stenosis of the pancreatic ducts . AJDC . 1942;64:443-454. 8. Fanconi G, Uehlinger E, Knauer C. Das Coeliakiesyndrom bei angeborener zystischer Pancreasfibromatose und Bronchiektasien . Wien Med Wochenschr . 1936;86:753-756. 9. Andersen DH. Cystic fibrosis of the pancreas and its relation to celiac disease . AJDC . 1938;56:344-399. 10. Farber SJ. The relation of pancreatic achylia to meconium ileus . J Pediatr . 1944;24:387-392.Crossref 11. Thomaidis TS, Arey JB. The intestinal lesions in cystic fibrosis of the pancreas . J Pediatr . 1963;63:444-453.Crossref 12. Fleischer AC, Davis RJ, Campbell L. Sonographic detection of a meconium-containing mass in a fetus: a case report . JCU . 1983;11:103. 13. Goldstein RB, Filly RA, Callen PW. Sonographic diagnosis of meconium ileus in utero . J Ultrasound Med . 1987;6:663-666. 14. Kalayoglu M, Sieber WK, Rodnan JB, Kiesewetter WB. Meconium ileus: a critical review of treatment and eventual prognosis . J Pediatr Surg . 1971;6:290-300.Crossref 15. West DK, Touloukian RJ. Meconium pseudocyst presenting as a buttock mass . J Pediatr Surg . 1988;23:864-865.Crossref 16. Rosenstein BJ. Cystic fibrosis presenting with the meconium plug syndrome . AJDC . 1978;132:167-169. 17. Olsen MM, Luck SR, Lloyd-Still J, Raffensperger JG. The spectrum of meconium disease in infancy . J Pediatr Surg . 1982;17:479-481.Crossref 18. Rescorla FJ, Grosfeld JL. Intestinal atresia and stenosis: analysis of survival in 120 cases . Surgery . 1985;98:668-676. 19. Neuhauser EBD. Roentgen changes associated with pancreatic insufficiency in early life . Radiology . 1946;46:319-328.Crossref 20. Hiatt RB, Wilson PE. Celiac syndrome: therapy of meconium ileus: report of eight cases with a review of the literature . Surg Gynecol Obstet . 1948;87:317-327. 21. Gross RE. The Surgery of Infancy and Childhood . Philadelphia, Pa: WB Saunders Co; 1953:175-191. 22. Olim CB, Ciuti A. Meconium ileus: a new method of relieving obstruction . Ann Surg . 1954;140:736-740.Crossref 23. Bishop HC, Koop CE. Management of meconium ileus: resection, Rouxen-Y anastomosis and ileostomy irrigation with pancreatic enzymes . Ann Surg . 1957;145:410-414.Crossref 24. Santulli TV, Blanc WA. Congenital atresia of the intestine: pathogenesis and treatment . Ann Surg . 1961;154:939-948. 25. Meeker IA Jr, Kincannon WN. Acetylcysteine used to liquify inspissated meconium causing intestinal obstruction in the newborn . Surgery . 1964;56:419-425. 26. Holsclaw DS, Eckstein HB, Nixon HH. Meconium ileus . AJDC . 1965;109:101-113. 27. Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report . J Pediatr Surg . 1969;4:190-197.Crossref 28. Frech RS, McAlister WH, Ternberg J, Strominger D. Meconium ileus relieved by 40 per cent water-soluble contrast enemas . Radiology . 1970;94:341-342.Crossref 29. Noblett H. Meconium ileus . In: Ravitch MM, Welch KJ, Benson CD, Aberdeen E, Randolph JG. eds. Pediatric Surgery . 3rd ed. Chicago, Ill: Year Book Medical Publishers Inc; 1979:943-952. 30. WaggetJ, Bishop HC, Koop CE. Experience with Gastrografin enema in the treatment of meconium ileus . J Pediatr Surg . 1970;5:649-654.Crossref 31. Lillie JG, Chrispin AR. Investigation and management of neonatal obstruction by Gastrografin enema . Ann Radiol . 1972;15:237. 32. Mabogunje OA, Wang CI, Mahour GH. Improved survival of neonates with meconium ileus . Arch Surg . 1982;117:37-40.Crossref 33. Nguyen LT, Youssef S, Guttman FM, Laberge JM, Albert D, Doody D. Meconium ileus: is a stoma necessary? J Pediatr Surg . 1986;21:766-768.Crossref 34. Caniano DA, Beaver BL. Meconium ileus: a fifteen year experience with forty-two neonates . Surgery . 1987;102:699-703. 35. Ein SH, Shandling B, Reilly BJ, Stephens CA. Bowel perforation with nonoperative treatment of meconium ileus . J Pediatr Surg . 1987;22:146-147.Crossref 36. Maneksha FR, Betta J, Zawin M, Poppers PJ. Intraoperative hypoxia and hypotension caused by Gastrografin-induced hypovolemia . Anesthesiology . 1984;61:454-456.Crossref 37. Grantmyre EB, Butler GJ, Gillis DA. Necrotizing enterocolitis after Renografin 76 treatment of meconium ileus . Am J Radiol . 1981;136:990-991. 38. Swenson O. Pediatric Surgery . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1962. 39. O'Neill JA, Grosfeld JL, Boles ET, Clatworthy NW Jr. Surgical treatment of meconium ileus . Am J Surg . 1970;119:99-105.Crossref 40. Harberg FJ, Senekjian EK, Pokorny WJ. Treatment of uncomplicated meconium ileus via T-tube ileostomy . J Pediatr Surg . 1981;16:61-63.Crossref 41. Venugopal S, Shandling B. Meconium ileus: laparotomy without resection, anastomosis, or enterostomy . J Pediatr Surg . 1979;14:715-718.Crossref 42. Grosfeld JL, Ballantine TVN, Shoemaker R. Operative management of intestinal atresia and stenosis based on pathologic findings . J Pediatr Surg . 1979;14:368-375.Crossref 43. MacDonald JA, Trusler GA. Meconium ileus: an eleven year review at the Hospital for Sick Children, Toronto, Canada . Can Med Assoc J . 1960;83:881-885. 44. Williams MPL. Chimney ileostomy: is closure a simple procedure? Presented at the British Association of Paediatric Surgeons 35th Annual International Congress; September 22, 1988; Athens, Greece.

Journal

Archives of Surgery – American Medical Association

Published: Jul 1, 1989

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