Management and survival of meconium ileus. A 30-year review.
Cystic fibrosis patients born with meconium ileus (MI) have had an improved outcome over the last three decades. The authors reviewed the impact of surgical management and long-term nutritional care on the survival of patients with MI. Of the 59 cases of MI seen from 1959 to 1989, 48 cases were managed operatively using either the Bishop-Koop ileostomy (BK), the Mikulicz ileostomy, primary resection and anastomosis (RA), or ileostomy. Six-month survival of MI has improved from 37% to 100%. Nonoperative cases (n = 11) had 100% long-term survival. The RA survivors required less late operative intervention (20%) as compared with other surgical patients (81%). A comparison of serial growth percentiles of CF patients with MI with those of their non-MI CF peers showed similar long-term decreases. These data confirm: (1) There is an improved survival for MI independent of the surgical procedure; (2) The BK ileostomy is an effective and time-tested MI treatment; (3) Primary resection and anastomosis in selected cases may have a lower surgical morbidity rate; and (4) Meconium ileus does not adversely affect the long-term nutritional outcome of CF patients.
Del Pin
C A
CA
Department of Surgery, Children's Hospital of Philadelphia, PA 19104.
Czyrko
C
C
Ziegler
M M
MM
Scanlin
T F
TF
Bishop
H C
HC
D016009:Chi-Square Distribution; D003550:Cystic Fibrosis / Q000150:complications; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000151:congenital* / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000151:congenital* / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008470:Meconium; D009752:Nutritional Status; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome