Meconium ileus
• It is the accumulation of abnormal meconium in the terminal ileum in infants with cystic fibrosis, causing intestinal obstruction.
• Clinical manifestations are caused by hyperviscous mucus secretions blocking the organ passages.
• The pancreas, lungs, sweat glands and small intestines are most affected.
• Abnormal amounts of sodium and chlorine are excreted with sweat.
• Progressive lung disease and secondary infections (Psuedomonos) develop as a result of mucus plugs.
• Mucus clogs the pancreatic duct and external secretions cannot be excreted. As a result, atrophy of the acinar cells and fibrosis of the pancreas occur.
• Meconium ileus is not seen in prematures.
Clinic and Diagnosis
It is an autosomal recessive disease.
There is biliary vomiting, abdominal distention, and inability to remove meconium.
On palpation of the abdomen, there are solid rubbery intestinal loops in the right lower quadrant.
There are two clinical types, simple and complex.
Simple type; It makes up 42%. It manifests itself with ileal obstruction within 24-48 hours, the terminal ileum is enlarged. The colon is in an unused state due to intrauterine obstruction.
complicated type; intestinal volvulus, perforation, meconium peritoneal pus, meconium pseudocyst, strangulation and intestinal atresia-stenosis. 50% of cases have small intestinal volvulus. Symptoms appear earlier. There is edema and erythema in the abdominal wall.
Radiology; In the direct abdominal X-ray, there is a frosted glass appearance (Neuhauser sign, soap bubble), calcification due to the ingestion of swallowed air into meconium.
There is an unused column appearance on the colon graph.
In the diagnosis of cystic fibrosis; sweat test, meconium strip test, Farber test, tryptic activity, immunoreactive trypsinogen determination, DNA analysis can be used.
Treatment
Treatment of simple meconium ileus is flushing with rectal irrigation.
Surgical; It is performed when the enema is unsuccessful, complicated by perforation, pseudocyst, atresia, or peritonitis, and the diagnosis is uncertain.
meconium plug syndrome
• Its incidence is 1/S00.
• It is a benign colonic obstruction.
• It occurs when the last 1-2 cm of the normally hard meconium cannot be removed just before or at birth.
• It can be easily expelled by rectal touch, thermometer or enema.
• There are lower gastrointestinal system symptoms and signs (abdominal distention, bilious vomiting, meconium regurgitation).
• ADBG has multiple liquid-gas levels consistent with distal occlusion.
Meconium peritonitis
• It is a sterile chemical peritonitis that occurs as a result of intestinal perforations occurring for various reasons in the last 6 months of intrauterine.
• It heals with intestinal adhesion and calcification.
• Meconium pseudocyst can result in adhesive plastic peritonitis, meconium ascites and infected meconium peritonitis, the worst course of which is infected meconium peritonitis.