Abstract
Purpose
Contrast enema is the initial study of choice for simple meconium ileus to confirm
diagnosis and to relieve obstruction. Despite favorable historically published results,
our clinical impression suggests decreased effectiveness of the contrast enema resulting
in more surgical interventions in contemporary practice.
Methods
A retrospective multiinstitutional review for a 12-year period was conducted for neonates
diagnosed with meconium ileus by contrast enema. The neonates were divided into 2
groups—historic group (HG = before 2002) and contemporary group (CG = after 2002).
T test was used for comparison of continuous variables and χ2 for categorical data.
Results
Thirty-seven total patients were identified (21 females and 16 males). Obstruction
was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient
was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the
CG group was 5.5% (1/18) compared to 39% (7/18) in HG.
Conclusions
In this review, success of contrast enema for relief of meconium ileus has significantly
decreased over time. These findings may be because of reluctance to repeat enemas,
change in radiologist experience, or use of contrast agent. As a result, higher rates
of operative intervention are now observed. In stable patients, surgeons should recommend
repeat enemas before exploration.
Key words
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References
- Survival rates in cystic fibrosis.Arch Dis Child. 1983; 58: 835-836
- Gastrointestinal manifestations of cystic fibrosis: a review.Gastroenterology. 1981; 81: 1143-1161
- A review of 164 children with meconium ileus seen at the Children's Hospital Medical Center.Boston Pediatr. 1966; 37: 833-850
- Meconium Ileus. A 20-year review of 109 cases.Am J Dis Child. 1965; 109: 101-113
- Meconium ileus: an eleven-year review at the Hospital for Sick Children, Toronto.Can Med Assoc J. 1960; 83: 881-885
- Contemporary management of meconium ileus.World J Surg. 1993; 17: 318-325
- Surgical considerations in cystic fibrosis: a 32-year evaluation of outcomes.Surgery. 2005; 138: 560-571
- Management and survival of meconium ileus. A 30-year review.Ann Surg. 1992; 215: 179-185
- Meconium ileus secondary to cystic fibrosis. The East London experience.Pediatr Surg Int. 1998; 13: 365-369
- Clinical outcome of cystic fibrosis presenting with or without meconium ileus: a matched cohort study.J Pediatr Surg. 2006; 41: 1556-1560
- Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report.J Pediatr Surg. 1969; 4: 190-197
- Experience with Gastrografin enema in the treatment of meconium ileus.J Pediatr Surg. 1970; 5: 649-654
- New strategies in nonoperative management of meconium ileus.J Pediatr Surg. 2002; 37: 760-764
- Bowel perforation with nonoperative treatment of meconium ileus.J Pediatr Surg. 1987; 22: 146-147
- Meconium ileus: a fifteen-year experience with forty-two neonates.Surgery. 1987; 102: 699-703
- The neonatal response to Gastrografin enema.Pediatrics. 1971; 48: 29-35
- Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology.Pediatr Radiol. 1995; 25: 97-100
Article info
Publication history
Accepted:
June 1,
2009
Received in revised form:
May 28,
2009
Received:
February 6,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.