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
From Wikipedia, the free encyclopedia 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 [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]
- Gangrene
About 40% of patients with meconimu ileus are complicated by intestinal volvulus, atresia, gangrene and necrosis, perforation, peritonitis with abdominal calcifi cations and, fi nally, meconial pseudocyst. [link.springer.com]
Surgical intervention to remove the cause of ileus is usually necessary when the obstruction is complete or the bowel is likely to become gangrenous. [medical-dictionary.thefreedictionary.com]
Explorative laparotomy on day 11 revealed complete volvulus with partial gangrene of the ileum. Therefore, 6 cm of ileum were resected and a T drainage was placed in order to decompress the small intestine. [bmcpediatr.biomedcentral.com]
On examination – Abdomen shows distention – Visible bowel loops – Tenderness, rigidity, abdominal wall edema and periumbilical flare- suggestive of peritonitis or gangrene of Bowel. – Although distension usually develops 12-24 hrs after birth, distension [slideshare.net]
Half the infants with uncomplicated meconium ileus, 18% with a perforation and 24% with gangrene of a loop of bowel survived. [cfmedicine.com]
- Poor Feeding
Any infant with delayed passage of meconium accompanied by vomiting, poor feeding, or abdominal distention should be evaluated urgently with a high index of suspicion for neonatal bowel obstruction. [cancertherapyadvisor.com]
Partial obstruction/ stenosis – Present weeks or months later with history of poor feeding, intermittent vomiting and failure to thrive – High Index of suspicion is required 80. prenatal • Polyhydramnios • Positive family history in patients with Type [slideshare.net]
Respiratoric
- Respiratory Insufficiency
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]
Keywords: Preterm infant Magnesium sulfate Meconium obstruction Respiratory insufficiency Heart failure Resumen Introducción El sulfato de magnesio (SMg) ha demostrado eficacia como neuroprotector en pretérminos < 32 semanas. [analesdepediatria.org]
Gastrointestinal
- Failure to Thrive
OBJECTIVE: 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. [ncbi.nlm.nih.gov]
Rarely, it presents later in childhood with symptoms of severe constipation and failure to thrive. [orpha.net]
Failure to thrive occurs unless these patients receive sodium supplementation. Complications In addition to pulmonary infection, many patients may have malabsorption, and intestinal obstruction. [shortbowelfoundation.org]
[…] to thrive Pancreatic disease Pancreatitis Exocrine pancreatic insufficiency Foul smelling steatorrhea ( fatty stools ) may occur. [amboss.com]
Cardiovascular
- Heart Disease
Down syndrome occurs in about one-quarter of these patients; congenital heart disease occurs in about 20 percent of them. [aafp.org]
Associated anomalies Associated anomaly percent Down syndrome 28.2 Annular pancreas 23.1 Congenital heart disease 22.6 Malrotation 19.7 EA/TEF 8.5 Genitourinary 8.0 Anorectal 4.4 Other bowel atresia 3.5 Other 10.9 None 45 19. [slideshare.net]
Congenital heart disease (30%), Trisomy 21 (30%), intestinal malrotation (20%), esophageal atresia, imperforate anus (10%–20%), thoracoabdominal heterotaxia, and gallbladder agenesis are common associations (Figure 5).20–22 Figure 5 Duodenal atresia in [dovepress.com]
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]
It has been observed that MI due to non-CF is more amenable to an enema therapy.[21] Since none of our patients had any problem in the postoperative period or during follow-up, we did not go for further workup to evaluate any other possible etiology. [jiaps.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]
Colonoscopy
- Colitis
Other nonionic contrast agents (eg, Hypaque, Omnipaque) are preferred by many radiologists and have less risk of dehydration or colitis. [emedicine.medscape.com]
Subsequent chapters focus on the technique, pitfalls and findings in a wide variety of applications, including antropyloric diseases bowel obstruction, bowel wall thickening, colitis, appendicitis, intussusception, some abdominal wall and umbilical abnormalities [books.google.ro]
[…] as clinical experience with olanzapine in patients with concomitant illness is limited, caution is advised when prescribing for patients with prostatic hypertrophy, or paralytic ileus and related conditions es No han encontrado ningún acelerador en Colitis [es.glosbe.com]
Nonionic contrast agents like Hypaque and Omnipaque are becoming popular with many radiologists since they have less risk of dehydration or colitis. [intechopen.com]
- Polyps
Symptoms in someone with cystic fibrosis include:• Fever• Increased shortness of breath• Sinus pain or pressure caused by infection or polyps 38. [slideshare.net]
[…] bile duct abnormalities Intestinal obstruction Abdominal distention, pain, and a palpable mass Rectal prolapse (rare) Respiratory Respiratory symptoms are frequent in adulthood Obstructive lung d isease with bronchiectasis Chronic sinu sitis ; nasal polyps [amboss.com]
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 [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]
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]
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]
[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]
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]
Newborn Surgery, Third Edition provides a comprehensive compendium of the pathophysiology, investigation and management of neonatal disorders. [books.google.ro]
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]
Fluid is replaced intravenously to prevent dehydration. If two or three enemas do not dislodge the obstruction, surgery is necessary. [medical-dictionary.thefreedictionary.com]