Evaluation of Non-Operative and Operative Management of Neonates with Meconium Ileus

S Luxna*
King's College London*
Meconium ileus represents the third most common cause of intestinal obstruction in neonates with an incidence of 1:2500 births. It is pathognomonic of cystic fibrosis. The gastrointestinal manifestations of cystic fibrosis contributing to the pathogenesis of meconium ileus include inspissated intestinal secretions secondary to abnormal fluid secretion and goblet cell hyperplasia, pancreatic insufficiency and abnormally viscid meconium. Antenatal diagnosis is made by sonography. Maternal polyhydramnios is the most common feature observed, evident in 20% of cases. Postnatally, abdominal radiographs are used and a definitive diagnosis of cystic fibrosis can be made via a sweat test. Treatment depends if neonate presents with simple or complex meconium ileus. While complex cases present a surgical emergency with a mortality of 25%, conservative non-surgical intervention, Gastrografin enema instillation are used first-line in simple cases. In enema failures, meconium is then surgically evacuated via enterotomy with saline irrigation. In complex meconium ileus, surgical intervention is indicated and resection with either primary anastomosis or ileostomy is used. With the help of more effective interventions coupled with earlier diagnosis, there has been a dramatic improvement of the one year survival rate from 10% to 90% since the 1940s. The management necessitates a multi-disciplinary approach to ensure pulmonary and nutritional health. This poster would depict a comparative review of these interventions: benefits, potential risks and complications, length of hospital stay, need for reoperation, mortality and long-term survival rates. Nevertheless, it is noteworthy that treatment is often individualized according to the clinical presentation of the neonate and surgeon preference.
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Luxna S.. Available From : http://www.pediatriconcall.com/conference/abstract/37/view/856
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