title: Issues in the management of simple and complex meconium ileus.
abstract: BACKGROUND
  Various surgical methods are used to treat meconium ileus (MI), including resection with enterostomy (RES), primary anastomosis (RPA), and purse-string enterotomy with intra-operative lavage (PSI). The aim of this study is to discuss the surgical treatment of MI, based on our experience.
  
  
  METHODS
  Of the 41 MI patients treated at our institution between 1984 and 2007, 18 had simple MI and 23 had complex MI. These groups were analyzed according to treatment modality, concentrating on length of hospital stay, complications [peritonitis, septicemia, adhesive small bowel obstruction (ASBO), and malabsorption/diarrhea], need for additional surgical procedures, mortality.
  
  
  RESULTS
  Of the 18 patients with simple MI, 7 (39%) were successfully treated with diluted Gastrografin® enema. The remaining 11 patients were treated surgically: two underwent RPA, of whom one died; five had RES, of whom one developed ASBO; four underwent PSI, of whom two developed peritonitis. In the complex MI group, 14 patients underwent RPA, with peritonitis occurring in three (one died); nine underwent RES, of whom two developed ASBO.
  
  
  CONCLUSIONS
  In patients with simple MI, conservative treatment with diluted Gastrografin® enema is an effective initial treatment in our hands. In case of failure, RES is advisable. Patients with complex MI are candidates for RES. RPA and PSI seem to have higher complication rates.
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Karimi
authors.forename: R R
authors.initials: RR
authors.lastname: Gorter
authors.forename: Chr
authors.initials: C
authors.lastname: Sleeboom
authors.forename: C M F
authors.initials: CM
authors.lastname: Kneepkens
authors.forename: H A
authors.initials: HA
authors.lastname: Heij
mesh_terms: D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery*; D045823:Ileus / Q000209:etiology* / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D008470:Meconium; D012189:Retrospective Studies; D012720:Severity of Illness Index