Meconium Ileus is usually a manifestation of cystic fibrosis. Meconium is normally stored in the infant's intestines until after birth, but sometimes it is expelled into the amniotic fluid prior to birth or during labor and delivery . Occasionally, however, meconium ileus may be seen in association with pancreatic atresia or stenosis of the pancreatic duct. Sometimes the meconium becomes thickened and congested in the ileum , a condition known as meconium ileus . Although air can flow past the meconium trapped in the baby's airways as the baby breathes in, the meconium becomes trapped in the airways when the baby breathes out. The condition also occurs in other individuals of other races. Meconium ileus results from a deficiency of trypsin and other digestive enzymes from the pancreas, as in cystic fibrosis (fibrocystic disease of the pancreas, mucoviscidosis).
Meconium Ileus is classified into two types:
(1) Simple meconium ileus: The distal small bowel (10-30 cm of distal ileum) is relatively small, measuring less than 2 cm in diameter and contains concretions of gray, inspissated meconium with the consistency of thick glue or putty. It is often beaklike in appearance, conforming to the shape of the contained pellets. Proximally, the mid-ileum is large, measuring up to 7 cm in diameter. It is greatly distended by a mass of extremely thick, tenacious, dark green or tarry meconium. The unused small colon (microcolon) contains a small amount of inspissated mucus or grayish meconium.
(2) Complicated meconium ileus: usually occurs during the prenatal period associated to volvulus, atresias, gangrene, perforation or peritonitis. A cystic mass or atresia of the bowel may occur. The degree of obstruction varies, may be cured in mild cases by rectal irrigations. Failure to pass meconium, abdominal distension and vomiting are seen in more severe cases.
These cases not withstanding, meconium ileus is usually taken to be synonymous with cystic fibrosis until proven otherwise, and meconium ileus is generally the earliest manifestation of the disease Meconium can be inhaled into the lungs when the baby gasps while still in the womb or during the initial gasping breaths after delivery. In meconium ileus, low or distal intestinal obstruction in results from the impaction of thick, tenacious meconium in the distal small bowel.
Cause of Meconium Ileus
Here are the list of the possible cause of Meconium Ileus:
Symptoms of Meconium Ileus
Some sign and symptoms related to Meconium Ileus are as follows :
Treatment of Meconium Ileus
Therapy is either:
(1) Nonoperative- should be tried first. It consist of a careful gastrograffin enema after the baby is well-hydrated. Gastrograffin is a hyperosmolar aqueous solution of meglumine diatrizoate containing 0.1% polysorbate-80 (tween-80, a wetting agent) and 37% iodine. Its success is due to the high osmolarity (1700 mosm/liter) which draws fluid into the bowel and softens and loosens the meconium.
(2) Surgical therapy - that has included: ileostomy with irrigation, resection with anastomosis, and resection with ileostomy (Mikulicz, Bishop-Koop, and Santulli). Post-operative management includes: 10% acetylcysteine p.o., oral feedings (pregestimil), pancreatic enzyme replacement, and prophylactic pulmonary therapy. Long-term prognosis depends on the degree of severity and progression of cystic fibrosis pulmonary disease.
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