Meconium ileus

Meconial ileus is the obstruction of the terminal ileum in abnormally viscous meconium; almost always this condition develops in newborns with cystic fibrosis. Meconial ileus constitutes up to 1/3 of all cases of small intestinal obstruction in newborns. Symptoms include vomiting, which can contain bile, bloating and the absence of meconium withdrawal. The diagnosis is based on clinical manifestations and radiographic data. In therapy, enemas with diluted contrast are used in fluoroscopy and surgical treatment in the absence of enema effect.

Meconial ileus is almost always an early manifestation of cystic fibrosis, in which all secrets in the digestive tract become very viscous and adhere to the intestinal mucosa. Obstruction occurs at the level of the terminal ileum (unlike colonic obstruction with meconium obstruction syndrome), usually develops in utero and can be diagnosed prenatally during ultrasound. Distal to the site of obstruction, the intestine is narrowed and does not contain or contains a small amount of meconium. Virtually free from the contents of the small intestine is called a microcolon.

Approximately half of the cases have such consequences as incomplete turn, intestinal atresia or perforation. Stretched loops of the small intestine in the prenatal period can be twisted, forming a valve. If, after this, the blood supply to the intestine is broken and a heart attack develops, this can lead to the emergence of sterile meconial peritonitis. The intestinal loop, in which the infarction developed, can resolve, after which areas of intestinal atresia are formed.

[1], [2], [3], [4], [5], [6], [7],

Symptoms of meconial ileus

Newborns with cystic fibrosis in a family history must undergo ultrasound testing every 6 weeks to detect meconial ileus. After birth in children with meconial ileus, there are usually manifestations of intestinal obstruction - either a simple form with bloating and lack of meconium, or more serious forms with the development of peritonitis and a respiratory distress syndrome. Loops of the dilated small intestine, which can sometimes be palpated through the anterior abdominal wall, have a characteristic testish consistency.

Diagnosis of meconial ileus

Diagnosis is suggested in newborns with signs of intestinal obstruction, especially if the family history is burdened by cystic fibrosis. Patients should perform an abdominal radiography that reveals stretched bowel loops and sometimes horizontal levels (at the boundary between air and fluid). The picture of "soap bubbles" due to the presence of small air bubbles, mixed with meconium, is a diagnostic sign of the mekonial ileus. If the child developed meconium peritonitis, calcified lumps of meconium may be located on the surface of the peritoneum and even in the scrotum. The study with barium identifies a micro-column with a clogged terminal terminal of the ileum.

Patients with diagnosed meconium ileus should be examined for cystic fibrosis.

[8], [9]

Treatment of meconial ileus

In uncomplicated cases (for example, without perforation, curvature or atresia of the intestine), obstruction can be eliminated by one or more administration of diluted radiopaque substance with Natsetiltsistein with fluoroscopy; less diluted (hypertonic) contrast can cause large fluid losses that require intravenous infusion. If there is no effect on the enema, laparotomy is necessary. Double ileostomy with the repeated introduction of Nacetylcysteine into the proximal and distal loops is usually necessary for liquefaction and removal of meconium.