New strategies in nonoperative management of meconium ileus.
OBJECTIVE
The aim of this study was to develop new nonoperative strategies for the management of meconium ileus in an attempt to improve on the current unacceptable failure rate.


METHODS
Mice were constipated with subcutaneous morphine injection. Each then received an enema solution (perflubron, surfactant, Tween-80, Gastrografin, Golytely, DNase, N-Acetylcysteine, Viokase, or normal saline). After the enema solution was administered, stool output was quantitated. Histologic examination of the intestines was performed on a second group of mice that also received enemas. Finally, viscosity measurements were taken of human meconium at baseline and after variable incubation periods with each test solution.


RESULTS
For relieving constipation in vivo, Gastrografin enema was most efficacious. All agents were equally benign to the intestinal mucosa. In vitro, only 4% N-Acetylcysteine and perflubron were less effective at decreasing meconium viscosity than normal saline at T = 0 hours, with N-Acetylcysteine producing greater reduction in viscosity than normal saline at T = 6 hours.


CONCLUSIONS
Our results show that surfactant and Gastrografin are the most effective for the in vivo relief of constipation. This is accomplished without mucosal damage. These agents also significantly reduce viscosity in vitro, and we speculate that they may be beneficial in relieving constipation caused by meconium ileus in cystic fibrosis patients.
Burke
Mark S
MS
Buffalo, New York, USA.
Ragi
Jennifer M
JM
Karamanoukian
Hratch L
HL
Kotter
Martin
M
Brisseau
Guy F
GF
Borowitz
Drucey S
DS
Ryan
Michael E
ME
Irish
Michael S
MS
Glick
Philip L
PL
D000818:Animals; D003248:Constipation / Q000209:etiology / Q000628:therapy; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D004733:Enema / Q000379:methods; D006801:Humans; D066298:In Vitro Techniques; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000150:complications / Q000473:pathology / Q000628:therapy*; D007422:Intestines / Q000473:pathology; D008297:Male; D008470:Meconium / Q000737:chemistry; D051379:Mice; D014783:Viscosity
D003974:Diatrizoate Meglumine