Diagnostics and treatment of meconium ileus in newborns

Abstract

Introduction. Meconium ileus is a disease characterized by the formation of thick, viscous meconium in the lumen of the small intestine with the development of low obstructive intestinal obstruction in newborns. Impaired meconium formation in children with cystic fibrosis is associated with a mutation of the CFTR gene, the development of apical dehydration of the secretory epithelium of the intestinal wall and excretory dysfunction of the pancreas. The aim of the review: to identify the leading mechanisms of formation of meconium ileus in newborn children to optimize its treatment. A review of the literature on the topic meconium ileus. In premature newborns, the development of obstructive intestinal obstruction is associated not only with the presence of dense meconium, but also with immaturity of the motor function of the gastrointestinal tract. Hyperechogenic masses in the intestinal lumen, calcifications in the abdominal cavity, dilation of intestinal loops, and free fluid in the abdominal cavity according to prenatal ultrasound indicate a high probability of cystic fibrosis in the fetus, which requires genetic counselling parents. One of the therapeutic and diagnostic methods for meconium ileus is the setting of a hypertensive enema with a water-soluble hyperosmolar contrast agent. This tactic being acceptable for use in simple forms of meconium ileus as a conservative therapy is effective in 25% of cases. Complicated forms of meconium ileus are characterized by the presence of secondary atresia, isolated inversion of the small intestine, severe ischemia or intestinal necrosis. In severe cases, meconium peritonitis develops simultaneously with perforation of the intestinal wall. Surgical methods for the treatment of simple and complicated forms of meconium ileus include washing meconium from the intestine with the imposition of primary anastomosis, alternative low-traumatic operations (enterotomy), as well as various options for stoma operations. However, a protocol for the treatment of meconium ileus has not yet been developed (including patients with cystic fibrosis). Difficulties remain in choosing the method of surgical correction of the meconium ileus of premature infants.