Presentation
A family history of cystic fibrosis was present in six children. Twenty-five neonates had uncomplicated meconium ileus due to inspissated meconium within the terminal ileum. [ncbi.nlm.nih.gov]
Clinical Presentation Term neonate presents with a distended abdomen and failure to pass meconium after 48 hours. Figure 60A Radiologic Findings Non-ionic contrast enema ( Fig. 60A1 ) in a 2-day-old girl demonstrates a microcolon. [radiologykey.com]
Entire Body System
- Neonatal Intestinal Obstruction
Neonatal Bowel obstruction Other names Neonatal intestinal obstruction Specialty Neonatology Neonatal bowel obstruction (NBO) or neonatal intestinal obstruction is the most common surgical emergency in the neonatal period.[1] It may occur due to a variety [en.wikipedia.org]
Intestinal obstruction is the most common surgical emergency in the neonatal period and a frequent cause for admission to the neonatal intensive care unit5,6. [imj.ie]
Abstract Meconium ileus, rare in Malaysia, accounts for 3.7% of all neonatal intestinal obstructions (excluding imperforate anus) seen in the University Hospital, Kuala Lumpur, from 1980-1990. [ncbi.nlm.nih.gov]
This site is intended for healthcare professionals General Practice Notebook Meconium ileus is a cause of neonatal intestinal obstruction caused by inspisated meconium. It is a neonatal manifestation about 10% of infants with cystic fibrosis. [gpnotebook.co.uk]
ABSTRACT Meconium ileus is a common cause of neonatal intestinal obstruction due to accumulation of inspissated meconium in terminal ileum and/ or colon. [medigraphic.com]
- Surgical Procedure
None required a second surgical procedure. CF was confirmed in all, and in each case, both parents were found to be genetic carriers of a mutational form of CF. [ncbi.nlm.nih.gov]
In some severe cases, surgical procedures may be needed. Testing for cystic fibrosis may be performed after a diagnosis of meconium ileus is made. Testing for cystic fibrosis may be performed after a diagnosis of meconium ileus is made. [wise-geek.com]
- Pain
In this paper we report of our experience with a 29-year-old male with a long-standing history of cystic fibrosis and recurrent abdominal pain. [ncbi.nlm.nih.gov]
The syndrome is usually one of subacute abdominal pain, restlessness and straining, and a positive finding on rectal examination. Occasional cases show severe pain and tympany of the large intestine. [medical-dictionary.thefreedictionary.com]
After a few days, acetaminophen (TYLENOL) should relieve her pain. Your child will also receive antibiotics after surgery to prevent infection. [chop.edu]
After this type of surgery, your child is likely to heal faster with less pain and go home from the hospital sooner. Children react to illness, injury, pain and medication differently than adults. [seattlechildrens.org]
- Fever
Your child will be ready to go home when her incisions are healing nicely, she doesn't have a fever, and is able to drink, urinate and have a bowel movement. This is usually in one to two weeks. [chop.edu]
Symptoms in someone with cystic fibrosis include:• Fever• Increased shortness of breath• Sinus pain or pressure caused by infection or polyps 38. [slideshare.net]
Fever. Shock. Diagnosis and Tests How is meconium ileus diagnosed? Diagnosis of meconium ileus can sometimes take place before birth. Your healthcare provider may see signs of a blockage on a prenatal ultrasound. [my.clevelandclinic.org]
This happens when part of the bowel ruptures, leading to fever and increased abdominal pain. These symptoms are a dangerous condition that requires surgery. [abanhospital.ir]
- Falling
The thin tapes over the incision (called STERI-STRIPS) will fall off on their own. Your child can have a tub bath one week after surgery. [chop.edu]
Rectal distention inhibits the internal anal sphincter, resulting in a fall in anal canal pressure. FIGURE 2A. [aafp.org]
Meconium had been thought to be sterile until researchers found bacterial communities in it so developed that they seemed to fall into two categories. [en.wikipedia.org]
If ganglion cells are present, a fall in anal pressure is seen. In Hirschsprung disease there is absent rectosphincteric reflex. Use of this test is difficult to perform and time-consuming, and requires patience in neonates. [accesspediatrics.mhmedical.com]
Respiratoric
- Pneumonia
Adynamic (or paralytic) ileus often accompanies peritonitis and is also found accompanying the colicky pains of gallstones or kidney stones; following spinal cord injury, pneumonia, or other generalized conditions; or being caused by peritoneal contamination [medical-dictionary.thefreedictionary.com]
[…] maximal oxygen uptake 最大酸素摂取量 maximal voluntary ventilation 最大努力呼吸/最大換気量 MVV mean corpuscular hemoglobin 平均赤血球ヘモグロビン量 MCH mean corpuscular hemoglobin concentration 平均赤血球ヘモグロビン濃度 MCHC mean corpuscular volume 平均赤血球容積 MCV measles croup 麻疹性クループ measles pneumonia [jpeds.or.jp]
Expiratory wheezing (obstruction), barrel chest, moist rales (indicate pneumonia ), hyperresonance to percussion Signs of chronic respiratory insufficiency: digital clubbing associated with chronic hypoxia Airway hyperreactivity (e.g., wheezing ) Sweat [amboss.com]
Stools that are pale or clay colored, foul smelling, have mucus, or that float• Symptoms related to the lungs and sinuses may include:• Coughing or increased mucus in the sinuses or lungs• Nasal congestion caused by nasal polyps• Recurrent episodes of pneumonia [slideshare.net]
Other infections that can result in intestinal dysfunction include pneumonia/enterovirus infection/omphalitis/peritonitis. Respiratory distress syndrome. [accesspediatrics.mhmedical.com]
- Dyspnea
10,000IU/kg/day, which could trigger fibrosing colonopathy. 22 The lungs may be affected since the period of CF neonatal screening, with 81% of cases showing structural abnormalities, 45% bronchial wall thickening, and 21% lung infection. 23 Cough and dyspnea [elsevier.es]
Gastrointestinal
- Vomiting
Clinical presentation included abdominal distension, bilious vomiting, and failure to pass meconium. In two recent cases, prenatal ultrasonography detected a mass with proximal bowel distension indicative of cystic meconium peritonitis. [ncbi.nlm.nih.gov]
There is vomiting and distention. [medical-dictionary.thefreedictionary.com]
Babies can experience discomfort or pain caused by constipation and trapped gas, and not want to feed Bilious vomiting. Green vomit, usually after the first feed Swollen belly. [bellybelly.com.au]
Features include: Abdominal distention with bilious vomiting is observed within the first 24 hours after birth. The more proximal the lesion, the earlier the bile-stained vomiting. X-ray shows air-fluid levels proximal to the lesion. [www3.health.vic.gov.au]
Symptoms for a real obstruction, compared to more common cases of constipation, are a distended abdomen, severe crying, and vomiting. [wise-geek.com]
- Abdominal Distension
Clinical presentation included abdominal distension, bilious vomiting, and failure to pass meconium. In two recent cases, prenatal ultrasonography detected a mass with proximal bowel distension indicative of cystic meconium peritonitis. [ncbi.nlm.nih.gov]
Clinical Course Within the first few days of life - abdominal distension fail to pass meconium and vomit bilious material Due either to the pulmonary complications of cystic fibrosis or the abdominal distension, infants often develop respiratory distress [johnsarm.net]
Clinical findings Non-passage of stool in the first two days of life, vomiting, abdominal distension. Complications Volvulus, intestinal infarction. [medical-dictionary.thefreedictionary.com]
He is noted to have abdominal distension. On review of his medical chart, his physician realizes that he failed to pass any meconium since being born. An abdominal radiograph reveals no perforation. [step1.medbullets.com]
Physical examination on admission was not remarkable except for abdominal distension with hyperactive bowel sounds. Roentgenograms of the abdomen showed multiple dilated loops of bowel without air-fluid levels. [pubs.rsna.org]
- Constipation
DIOS and constipation are frequently seen in cystic fibrosis patients, especially later in life; genetic, dietary, and other associations have been explored. [ncbi.nlm.nih.gov]
Results: For relieving constipation in vivo, Gastrografin enema was most efficacious. All agents were equally benign to the intestinal mucosa. [jpedsurg.org]
If the neonate has bilious vomiting, constipation and distended abdomen --> Hirschsprung's, not duodenal atresia or annular pancreas, since these latter two don't present with constipation or abdominal distension to the same extent as the former, despite [forums.studentdoctor.net]
- Bilious Vomiting
Clinical presentation included abdominal distension, bilious vomiting, and failure to pass meconium. In two recent cases, prenatal ultrasonography detected a mass with proximal bowel distension indicative of cystic meconium peritonitis. [ncbi.nlm.nih.gov]
[…] also presenting with bilious vomiting. [forums.studentdoctor.net]
Abdominal distention with bilious vomiting is observed within the first 24 hours after birth. [aafp.org]
In 80% of cases the papilla of Vater opens into the proximal duodenum causing the vomiting to be bilious. [www3.health.vic.gov.au]
- Intestinal Perforation
Complications such as atresia, perforation, and meconium peritonitis may necessitate bowel resection, intestinal anastomosis, and ileostomy. [patientcareonline.com]
(Usually when the intestine is perforated, the surgeon must remove that segment.) [seattlechildrens.org]
Taking these findings into account, a complete resection of the mass, a release of intestinal adhesions and a suture of the intestinal perforation, in a transverse direction, were made. [revistas.unal.edu.co]
Meconial Peritonitis (MP) is a chemical, sterile, inflammatory reaction of the visceral and parietal peritoneum, intestinal loops and mesenterium, produced by a prenatal intestinal perforation. [scielo.conicyt.cl]
Skin
- Erythema
Remarkable abdominal distention, abdominal tenderness, or abdominal erythema indicates perforation. [patientcareonline.com]
Signs of meconium peritonitis ( Abd distension, tenderness, abdominal wall erythema), clinical evidence of sepsis. intraperitoneal calcifications on abdominal X-rays. complications include: perforation, meconium peritonitis, volvolus and atresia meconium [slideshare.net]
Remarkable abdominal distention, tenderness and/or erythema of the abdominal skin indicates perforation, which requires immediate surgery. [aafp.org]
Presentation of meconium ileus Presentation includes: early marked bowel distension bilious vomiting remarkable abdominal distention, tenderness and/or erythema of the abdominal skin may indicate perforation on rectal examination mucus plugs may be evacuated [www3.health.vic.gov.au]
Urogenital
- Cesarean Section
KEYWORDS: Previous cesarean section; Scar thickness; Second trimester; Transvaginal sonography; VBAC [ncbi.nlm.nih.gov]
Treatments for this condition may include administering antibiotics intravenously if delivery is imminent, or an emergency cesarean section if labor has not begun or his not far enough progressed. [wise-geek.com]
section ( J Obstet Gynaecol 2007;27:660 ) Back to top [pathologyoutlines.com]
The newborn was term and born via cesarean-section with a normal Apgar score. There was no history of vomiting. Physical examination and abdominal X-ray showed no signs of gastro-intestinal obstructive disorders. [oatext.com]
Terminal meconium occurs when the fetus passes the meconium a short enough time before birth/cesarean section that the amniotic fluid remains clear, but individual clumps of meconium are in the fluid. [en.wikipedia.org]
Workup
As such, patients should receive further workup with echocardiogram (preferably before surgery), CXR for vertebral anomalies, renal ultrasonography Anal stenosis accounts for 20% of anorectal anomalies and treatment is with dilatation Malrotation and [pedclerk.bsd.uchicago.edu]
It is best to only do a diagnostic workup for intestinal obstruction in those premature infants with other signs of GI disease (eg, progressive abdominal distension and vomiting). [accesspediatrics.mhmedical.com]
Workup usually involves abdominal radiography, which may direct further evaluation with fluoroscopic examination such as an UGI contrast study or contrast enema. [dovepress.com]
Management • It consists of pre operative stabilization and Surgical Management • Preoperative stabilization and workup – Nil per orally + ryles tube aspiration – Intravenous fluids – Intravenous antibiotics – inj vitamin K – Warmth care – Rule out associated [slideshare.net]
X-Ray
- Bowel Distention
The first signs of the condition include vomiting and bowel distention shortly after birth. Obstructions may be unblocked by using medications to liquefy and release the meconium. In some severe cases, surgical procedures may be needed. [wise-geek.com]
Late perforations, usually occurring 12–48 hours after the enema, may be due to direct injury to the bowel mucosa by the contrast medium, severe bowel distention by fluid osmotically drawn into the intestine, or extensive bowel necrosis. [intechopen.com]
After a few hours of postnatal life, bowel distention becomes remarkable because of swallowed air and causes bilious vomiting. In some cases, meconium retention may cause dystociaproducing abdominal distention. [aafp.org]
Abdominal radiographs show signs of lower intestinal obstruction with variable abdominal bowel gas, bowel distention, and air-fluid levels. These radiographic findings are nonspecific; hence, barium enema must be performed. [jaocr.org]
Microbiology
- Pseudomonas
There were no significant differences in genotype, sex, chronic Pseudomonas infection, or pancreatic enzyme use between the two groups. The median age of diagnosis was 1 day (MI) versus 7 months (non-MI). [ncbi.nlm.nih.gov]
Treatment
The clinical diagnosis was oligohydramnios and abruptio placentae, respiratory failure, and anuria refractory to treatment. The autopsy revealed meconium ileus and meconium peritonitis. [ncbi.nlm.nih.gov]
Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. Journal of Pediatric Surgery, 4 (2), pp. 190-7. Noblett HR. Treatment of Uncomplicated Meconium Ileus By Gastrografin Enema: a Preliminary Report. [unboundmedicine.com]
Prognosis
Prevention, and Complications Prognosis low risk of mortality with treatment likely to develop other conditions in life bowel obstructions Complications intussusception segmental volvulus meconium peritonitis Please rate topic. [step1.medbullets.com]
Ultrasound Prenatal ultrasound findings associated with meconium ileus include echogenic bowel, which can be dilated and thick walled polyhydramnios fetal ascites peritoneal wall calcifications intra-abdominal cysts Treatment and prognosis Water-soluble [radiopaedia.org]
METHODS: We identified areas of interest including pathophysiology, prenatal diagnosis, nonoperative and operative management, postoperative management, and prognosis. [ncbi.nlm.nih.gov]
Outlook / Prognosis What is the outlook if my baby has meconium ileus? The prognosis for even complicated cases of meconium ileus is usually good. Meconium ileus is often a sign of cystic fibrosis. [my.clevelandclinic.org]
Etiology
However, other rare and challenging etiologies such as congenital chloride diarrhea (CCD) should be included in differential diagnosis of such presentation. [ncbi.nlm.nih.gov]
Etiology Almost all cases are associated with an underlying diagnosis of cystic fibrosis (CF). Conversely, meconium ileus is the initial presentation of 10 to 15% of CF cases. [radiologykey.com]
Meconium ileus (& Hirschprung, Malrotation) Meconium ileus is the third most common etiology of neonatal small bowel obstruction, accounting for 9% to 33% of cases. [johnsarm.net]
Epidemiology
Epidemiology Meconium ileus is more common in white populations and affects both sexes almost equally. [pacs.de]
2018 Calificadores Permitidos Inglés : BL blood CF cerebrospinal fluid CI chemically induced CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology [decs.bvs.br]
[1] References: [1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Summary Epidemiology HSCR has an estimated annual incidence of 1/5,000 births. Short segment HSCR is more frequent in males. [orpha.net]
The outcome is in part dependent upon congenital comorbidities and delays in diagnosis and management.[7] Epidemiology[edit] It has an estimated incidence of about 1 in 2000 live births.[4] References[edit] ^ Vinocur, Daniel N.; Lee, Edward Y.; Eisenberg [en.wikipedia.org]
Pathophysiology
METHODS: We identified areas of interest including pathophysiology, prenatal diagnosis, nonoperative and operative management, postoperative management, and prognosis. [ncbi.nlm.nih.gov]
A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon. Journal of Pediatric Surgery 2012;47:772–781. Gorter RR, Karimi A, Sleeboom Chr, et al. [medigraphic.com]
Carlyle BE, Borowitz DS, Glick PL: Review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon. Journal of Pediatric Surgery 47:772-81. [journals.sbmu.ac.ir]
Prevention
Comparing CFTR expression in different lines revealed that approximately 20% of wild-type CFTR mRNA largely prevented meconium ileus. This model may be of value for understanding CF pathophysiology and testing new preventions and therapies. [ncbi.nlm.nih.gov]
Your baby will require a drip to deliver fluids, so as to prevent dehydration Antibiotics. They are given to prevent infection if damage or tearing in the bowel causes the contents to spill into the abdominal cavity Breathing support. [bellybelly.com.au]