<h1>Meconium ileus</h1>

What is meconium ileus ?

Meconium ileus is represented by a accumulation of viscous meconium, adherent to the wall of the small intestine which is frequently associated with mucoviscidosis . The disease is caused by a fibrocystic degeneration of the exocrine glands in structures derived from the primitive intestine:

1. Pancreas
2. Trachea and its ramifications 
3. Pulmonary alveoli  

What causes meconium ileus ?

Meconium can not be eliminated leading obstruction of the intestine with an occlusive pattern, the proximal intestinal loop beeing dilated and the distal one being hypoplastic

Morphological changes in meconium ileus

1. Unequal caliber and thickness between the proximal and distal intestinal loops 
2. Adherent meconium in the intestinal lumen 
3. The pproximal intestinal loop may or may not be volvulated 
4. Reduced trypsin secretion by the glands situated in the intestinal wal

Clinical findings in meconium ileus

1. Intestinal occlusion pattern, with a characteristic aspect of the abdomen 
2. The meconium is hardly removed from the glove after digital rectal examination 

Labratory tests in meconium ileus

1. Aminopeptidase levels determination
2. Gama-glutmyltransfarase  levels determination 
3. Sweat tes

Radiologic findings consistent with occlusive  syndrome
Differential diagnosis with occlusive malformations

Meconium ileus treatment

The treatment is adapted to the clinical presentation form and the stage of te disease at which a diagnosis reached

1. Gastrografin enema under radiographic control. Gastrografin leads to an increased osmotic concentration in the intestinal lumen which determines water to flow from the intestinal wall capillary into the intestinal lumen.
2. Laparotomy in order to reestablish the permeability of the intestinal lumen
3. Gastrografin injections through the intestinal lumen
4. Ileostomy and intraluminal drainage tube followed by gastrogrfin instillation
5. Resection of the affected segment and termino-terminal restoration of the intestinal continuity
6. Ileostomy

• Lateral ileostomy
• Y ileostomy whitth adjacent intestinal loop exteriorized to the abdominal wall
• Mikulicz ileostomy

Prognosis is poor, depending in great measure on whether cystic fibrosis is associated or not