meconium ileus


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ileus

 [il´e-us]
failure of appropriate forward movement of bowel contents. It may be secondary to either mechanical obstruction of the bowel (mechanical ileus) or a disturbance in neural stimulation (adynamic ileus). Ileus is a surgical emergency that may or may not require surgical intervention; the cause needs to be established promptly.

Adynamic (or paralytic) ileus often accompanies peritonitis and is also found accompanying the colicky pains of gallstones or kidney stones; following spinal cord injury, pneumonia, or other generalized conditions; or being caused by peritoneal contamination by pus (from a perforated appendix) or acid (from a perforated ulcer). Mechanical ileus is that due to adhesions, ischemia, tumor, or stone and requires prompt decompression of the bowel to prevent perforation.
Symptoms. The principal symptoms of ileus are abdominal pain and distention, constipation, and vomiting in which the vomitus may contain fecal material. If the intestinal obstruction is not relieved, the circulation in the wall of the intestine is impaired and the patient appears extremely ill with symptoms of shock and dehydration.
Treatment. Distention of the abdomen is relieved by decompression, which involves intubation with a long, balloon-tipped tube (e.g., miller-abbott tube) that extends to the site of the obstruction, and use of constant suction. Because of the disruption in absorption of fluids and nutrients from the intestinal tract, fluids, electrolytes, and glucose are given intravenously. Surgical intervention to remove the cause of ileus is usually necessary when the obstruction is complete or the bowel is likely to become gangrenous. The type of surgical procedure will depend on the condition of the bowel and the cause of the obstruction. In some cases ileostomy or colostomy, either temporary or permanent, may be necessary. In cases of paralytic ileus due to causes other than contamination by pus or acid, tube decompression may be sufficient, but even in these patients, surgery may be needed to protect the bowel from overdistention and perforation. See also intestinal obstruction for patient care.
adynamic ileus that caused by inhibition of bowel motility; see ileus.
dynamic ileus (hyperdynamic ileus) spastic ileus.
mechanical ileus that caused by a mechanical cause, such as hernia, adhesions, or volvulus; see ileus.
meconium ileus ileus in the newborn due to intestinal obstruction by thick meconium.
paralytic ileus adynamic ileus.
spastic ileus that due to persistent contracture of a bowel segment.
ileus subpar´ta ileus due to pressure of the gravid uterus on the pelvic colon.

me·co·ni·um il·e·us

intestinal obstruction in the fetus and newborn following inspissation of meconium and caused by lack of trypsin; associated with cystic fibrosis.

meconium ileus

obstruction of the small intestine in the newborn caused by impaction of thick, dry, tenacious meconium, usually at or near the ileocecal valve. Symptoms include abdominal distension, vomiting, failure to pass meconium within the first 24 to 48 hours after birth, and rapid dehydration with associated electrolyte imbalance. The condition results from a deficiency in pancreatic enzymes and is the earliest manifestation of cystic fibrosis. In uncomplicated cases in which perforation, volvulus, or atresia does not occur, the obstruction may be relieved by giving enemas with a contrast medium, such as a hypertonic solution of meglumine diatrizoate and sodium diatrizoate, under fluoroscopy. Fluid is replaced intravenously to prevent dehydration. If two or three enemas do not dislodge the obstruction, surgery is necessary. See also meconium plug syndrome.

meconium ileus

A condition characterised by obstruction of the neonatal intestine by meconium that may be confined to the ileus, a finding characteristic of cystic fibrosis.
 
Clinical findings
Non-passage of stool in the first two days of life, vomiting, abdominal distension.

Complications
Volvulus, intestinal infarction.
 
DiffDx
Meconium “plugging” of the rectum may also signal the presence of Hirschsprung’s disease, which is histologically characterised by segmental aganglionosis.

meconium ileus

Meconium plug syndrome Obstetrics A condition characterized by obstruction of the neonatal intestine by meconium that may be confined to the ileus, a finding characteristic of cystic fibrosis Clinical Non-passage of stool in the first 2 days of life, vomiting, abdominal distension Complications Volvulus, intestinal infarction

me·co·ni·um il·e·us

(mě-kō'nē-ŭm il'ē-ŭs)
Intestinal obstruction in the fetus and newborn following inspissation of meconium; caused by lack of trypsin; associated with cystic fibrosis.

meconium ileus

Obstruction of the intestine in a new-born baby with CYSTIC FIBROSIS due to failure of digestion of the MECONIUM which becomes very firm and packs the lower ILEUM with a putty-like material. There is vomiting and distention. Surgery may be needed to remove the obstructed section of the bowel.

meconium

yellow-orange mucilaginous material in the intestine of the full-term fetus; it constitutes the first stools passed by the newborn.

meconium aspiration
aspiration of fragments of meconium into the pulmonary airways occurs in the fetus in the terminal stages of many infections.
meconium ileus
intestinal obstruction in the newborn due to the blocking of the bowels with thick meconium. This is an important disease of newborn colt foals. The syndrome is usually one of subacute abdominal pain, restlessness and straining, and a positive finding on rectal examination. Occasional cases show severe pain and tympany of the large intestine. Called also meconium retention.
meconium retention
see meconium ileus (above). See also impaction colic.
References in periodicals archive ?
Genetic comparisons of patients with cystic fibrosis with or without meconium ileus.
Effect of meconium ileus on the clinical prognosis of patients with cystic fibrosis.
Detection of a cystic fibrosis modifier locus for meconium ileus on human chromosome 19q13.
The abnormal patterns observed in CF reflect meconium ileus and are not observed in CF carriers; however, these patterns are not specific to CF and can be observed in fetal digestive tract malformations, cytomegalovirus infection, or fetal distress (14).
Failure of medical treatment in an adult cystic fibrosis patient with meconium ileus equivalent.
The patient (present age, 18 years), born without meconium ileus, was diagnosed at the age of 1 year; the sweat chloride result was 93 mEq/L.
The latter, born without meconium ileus, was diagnosed at the age of 2 years; the sweat chloride result was 70 mEq/L.
No Congenital Anomaly Age Range Male 1 Hirschsprung's Disease 0-12 yrs 114 2 Omphalomesenteric duct 0-15 yrs 37 remnants 3 Intestinal Atresia 0-1 month 17 4 Meconium Ileus 0-1 month 10 5 Duplication Cysts 0-10 yrs 8 6 Mesenteric Cysts 0-5 yrs 5 7 Chylolymphatic Cysts 1-10 yrs 5 8 Web/Stenosis 0-8 yrs 3 9 Meconium Cyst 0-7 days 2 10 Malrotation 0-10 month 1 11 Heterotopic Pancreas 0-5 yrs 1 12 Inspissated Bile Syndrome 1-6 month 2 13 Recto-vaginal Fistula 1-5 yrs 0 14 Tracheo-esophageal fistula 1yr 0 (TOF) 15 TOF + Esophageal Atresia 5 days 0 16 Anal Fistula 12 days 1 17 Ectopia vesicae with 7 Months 1 Duplication Cysts 18 Imperforate Anus 1 day 1 Total 208 78 286 S.