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World Journal of Gastroenterology Sep 2023Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious... (Review)
Review
Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung's disease (HD), meconium ileus due to Cystic Fibrosis, The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis, such as anorectal manometry or rectal suction biopsy. What if there was another etiology of perinatal constipation, that is far lesser known? Cow's milk protein allergy (CMPA) is often diagnosed in infants within the first few weeks of life, however, there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero, therefore allowing symptoms to show as early as day one of life. The presentation is more atypical, with perinatal constipation rather than with bloody stools, diarrhea, and vomiting. The diagnosis and management would be avoidance of cow's milk protein within the diet, with results and symptom improvement in patients immediately. Therefore, we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients. This entails first ruling out CMPA with safe, noninvasive techniques with diet modification, and if unsuccessful, then moving forward with further diagnostic modalities.
Topics: Animals; Cattle; Female; Infant; Pregnancy; Humans; Milk Hypersensitivity; Constipation; Biopsy; Diarrhea; Hirschsprung Disease
PubMed: 37731998
DOI: 10.3748/wjg.v29.i33.4920 -
The Journal of Pediatric Pharmacology... 2019With the improving life expectancy of cystic fibrosis patients, new manifestations of the disease are emerging. Distal intestinal obstruction syndrome is one of the... (Review)
Review
With the improving life expectancy of cystic fibrosis patients, new manifestations of the disease are emerging. Distal intestinal obstruction syndrome is one of the increasingly noted complications. Traditionally this syndrome was treated surgically. -acetylcysteine is sometimes used as a non-surgical treatment option despite lack of definitive evidence for its efficacy and safety and not being mentioned in current treatment guidelines. The existing case reports suggest that -acetylcysteine may have a place in therapy for older patients with incomplete distal intestinal obstruction syndrome to relieve the initial obstruction or following disimpaction to ensure clearance of remaining ileus and to prevent obstruction recurrence. In younger patients (e.g., <3 years of age), efficacy of -acetylcysteine has been controversial and its use has been associated with drug-induced liver injury and hypernatremia. In the cases included in this review, 4% -acetylcysteine was the formulation most commonly used. Since higher concentrations have been associated with increased adverse effects and mucosal injury, lower concentrations and dosages should be used when using -acetylcysteine until further evidence becomes available. Proper administration technique and monitoring parameters are not well defined in current literature. Prospective, well-designed clinical trials are lacking and would be helpful to better define the role of -acetylcysteine in distal intestinal obstruction syndrome.
PubMed: 31598102
DOI: 10.5863/1551-6776-24.5.390 -
Eastern Mediterranean Health Journal =... Jan 2000We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure...
We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction (27.8%) followed by duodenal atresia (13.9%) and colonic atresia and meconium ileus (11.1% each). There were 8 deaths following surgery (22% mortality rate), the main causes being aspiration pneumonia, septicaemia and hypothermia.
Topics: Age Distribution; Anus, Imperforate; Cause of Death; Colon; Duodenum; Female; Hospital Mortality; Hospitals, General; Humans; Infant Mortality; Infant, Newborn; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Iraq; Male; Meconium; Retrospective Studies; Sex Distribution
PubMed: 11370333
DOI: No ID Found -
Archives of Disease in Childhood Apr 1972The results of surgery for meconium ileus obstruction (37 cases) at Queen Elizabeth Hospital for Children, London, during the years 1953 to 1970 are presented. The...
The results of surgery for meconium ileus obstruction (37 cases) at Queen Elizabeth Hospital for Children, London, during the years 1953 to 1970 are presented. The surgical survival was 30% in the years 1953 to 1961, and 70% in the years 1962 to December 1970, inclusive. The long-term survival was 57%. Complications, such as small bowel atresia, gangrene, and meconium peritonitis, were associated with a higher mortality. The adoption of the Bishop Koop operation in 1962 coincided with the increase in the survival rate. An association between meconium ileus and hypertrophic pyloric stenosis was noted.
Topics: Age Factors; Birth Weight; Cystic Fibrosis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Postoperative Complications; Pyloric Stenosis; Time Factors
PubMed: 5023467
DOI: 10.1136/adc.47.252.207 -
Journal of Cystic Fibrosis : Official... Nov 2019
Topics: Cohort Studies; Correlation of Data; Cystic Fibrosis; Delayed Diagnosis; Humans; Infant, Newborn; Meconium Ileus; Mortality; Patient Care Management; Prognosis; Severity of Illness Index
PubMed: 31668933
DOI: 10.1016/j.jcf.2019.10.003 -
Annals of Surgical Treatment and... Sep 2015One of the major causes of bowel obstruction in extremely premature infants is a meconium obstruction. However, there are many challenges not only in the recognition and...
PURPOSE
One of the major causes of bowel obstruction in extremely premature infants is a meconium obstruction. However, there are many challenges not only in the recognition and diagnosis, but also in the management of meconium obstruction. This study aimed to find perioperative clinical features and determine the postoperative course of meconium-related ileus in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.
METHODS
We retrospectively reviewed the clinical data of premature infants (n = 11, VLBW infnats; n = 16, ELBW infants) with a meconium-related ileus who underwent operation for intractable ileus between January 2009 and May 2013.
RESULTS
The average duration of conservative management was longer and postnatal age was older in ELBW infants than VLBW infants: 19.9 days vs. 11.5 days and 34.9 days vs. 19.2 days. The immediate postoperative course (day that beginning feeding and full feeding) was not significantly different based on birth weight, but the ELBW infants had slightly higher mortality. At 12 months of corrected age after operation, both average body weight and average height was below 10th percentile for growth in most infants (61.1%).
CONCLUSION
There was a slightly high mortality in the ELBW infants, but two groups did not experience significant differences in the immediate postoperative course of meconium-related ileus. Nevertheless, considering their growth patterns, it is necessary to do a close follow-up and more aggressive nutritional management to achieve optimal growth and development in both patient groups.
PubMed: 26366385
DOI: 10.4174/astr.2015.89.3.151 -
Canadian Medical Association Journal Feb 1936
PubMed: 20320161
DOI: No ID Found -
Arquivos Brasileiros de Cirurgia... 2020Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop... (Comparative Study)
Comparative Study
BACKGROUND
Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop ileostomy.
AIM
To evaluate and compare clinical efficacy of Santulli and loop ileostomy in neonates with meconium ileus.
METHODS
In this retrospective study, 58 patients with meconium ileus were evaluated. After analyses of hospital records, 53 patients with completed hospital records were included. Demographic information, surgery parameters and postoperative complications were extracted from the hospital records or calling parents.
RESULTS
Skin excoriation (21.4% vs. 84%, p<0.001), ostomy prolapsed (0 vs. 28%, p=0.003), and surgical site infection (7.1% vs. 28%, p=0.044) was significantly lower in Santulli ileostomy group. Furthermore, ileostomy output in first week (70.53±15.11 ml vs. 144.6±19.99 ml, p<0.001) and in 4th week (2.14±4.98 ml vs. 18.4±17.95 ml, p<0.001) was significantly lower in Santulli ileostomy group as compared to loop ileostomy group. Finally, hospital stay in Santulli ileostomy group was 12±2.34 and in loop ileostomy 14.24±1.47 days (p<0.001).
CONCLUSION
Santulli ileostomy is better than loop ileostomy due to significant less frequency of surgical site infection, skin excoriation, prolapse of ostomy, ileostomy volume output and hospitalization time.
Topics: Female; Humans; Ileostomy; Infant, Newborn; Intestinal Obstruction; Length of Stay; Male; Meconium Ileus; Postoperative Complications; Retrospective Studies
PubMed: 33206844
DOI: 10.1590/0102-672020190001e1485 -
Arquivos Brasileiros de Cirurgia... 2020Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop... (Comparative Study)
Comparative Study
BACKGROUND
Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop ileostomy.
AIM
To evaluate and compare clinical efficacy of Santulli and loop ileostomy in neonates with meconium ileus.
METHODS
In this retrospective study, 58 patients with meconium ileus were evaluated. After analyses of hospital records, 53 patients with completed hospital records were included. Demographic information, surgery parameters and postoperative complications were extracted from the hospital records or calling parents.
RESULTS
Skin excoriation (21.4% vs. 84%, p<0.001), ostomy prolapsed (0 vs. 28%, p=0.003), and surgical site infection (7.1% vs. 28%, p=0.044) was significantly lower in Santulli ileostomy group. Furthermore, ileostomy output in first week (70.53±15.11 ml vs. 144.6±19.99 ml, p<0.001) and in 4th week (2.14±4.98 ml vs. 18.4±17.95 ml, p<0.001) was significantly lower in Santulli ileostomy group as compared to loop ileostomy group. Finally, hospital stay in Santulli ileostomy group was 12±2.34 and in loop ileostomy 14.24±1.47 days (p<0.001).
CONCLUSION
Santulli ileostomy is better than loop ileostomy due to significant less frequency of surgical site infection, skin excoriation, prolapse of ostomy, ileostomy volume output and hospitalization time.
Topics: Humans; Ileostomy; Infant, Newborn; Intestinal Obstruction; Length of Stay; Meconium Ileus; Postoperative Complications; Retrospective Studies
PubMed: 33331433
DOI: 10.1590/0102-672020200003e1538 -
Journal of Cystic Fibrosis : Official... Nov 2019Meconium ileus (MI) affects up to 20% of newborns with cystic fibrosis (CF). We compared clinical outcomes between Australian paediatric CF patients with and without...
BACKGROUND
Meconium ileus (MI) affects up to 20% of newborns with cystic fibrosis (CF). We compared clinical outcomes between Australian paediatric CF patients with and without meconium ileus (non-MI).
METHODS
This was a retrospective case-control study of MI and non-MI patients in New South Wales, Australia, from 1988 to 2010. MI patients were matched 1:1 with pancreatic insufficient non-MI patients for age, sex and CF clinic. Clinical measurements, nutrition and gastrointestinal outcomes over this period were compared between groups using linear mixed models for continuous variables to account for age.
RESULTS
There were 162 matched pairs (N=324, 52% female) with mean (SD) age of 15.3 (8.2) and 14.9 (7.9) years for MI and non-MI patients respectively (P=0.6). MI patients aged 5-23 had poorer FEV1% compared to non-MI patients (estimate -0.070 SE [0.02], P=0.003). There were no significant differences in P. aeruginosa isolation rates; however S. aureus isolation rates were lower in MI patients (72%) compared to non-MI (82%) (OR 0.6 [0.3-1.0], P=0.03). Chronic colonisation rates for P. aeruginosa and S. aureus were not significantly different between groups. MI patients aged 2-20 had significantly lower BMI Z-scores over time (estimate -0.25 SE [0.1], P=0.02). MI patients were more likely to receive oral feed supplements (OR 2.8 [1.4-6.1], P=0.003) and gastrostomy formation (OR 4.4 [1.1-24.6], P=0.02).
CONCLUSIONS
CF patients with MI may have worse lung function, growth and nutrition than non-MI patients over time. Meconium ileus may be an early poor prognostic factor for CF.
Topics: Adolescent; Australia; Case-Control Studies; Cystic Fibrosis; Early Diagnosis; Exocrine Pancreatic Insufficiency; Female; Growth Disorders; Humans; Infant, Newborn; Male; Malnutrition; Meconium Ileus; Nutritional Status; Prognosis; Pseudomonas aeruginosa; Respiratory Function Tests; Respiratory Tract Infections; Retrospective Studies; Staphylococcus aureus
PubMed: 31672555
DOI: 10.1016/j.jcf.2019.09.008