Paediatrics: Meconium ileus

Meconium ileus

The incidence of MCI is 71/2500 live births. MCI is associated with cystic fibrosis (CF): 15% of children with CF present with MCI. Lack of pan-creatic enzymes results in meconium that is thick and viscous causing an intraluminal obstruction in the terminal ileum. Occasionally the distended obstructed bowel will perforate or result in volvulus in utero, so-called ‘complicated’ MCI. Babies present at birth with intestinal obstruction.

Management

Treatment of MCI involves relieving the intestinal obstruction.

•   Gastrograffin enema: provided that there is no evidence of intra-uterine perforation the obstruction may be relieved by hypertonic contrast, which draws fluid into the bowel lumen, and the detergent then loosens inspissated meconium.

•   Laparotomy for unsuccessful enema or complicated MCI.

Management of CF if diagnosed.