2012, Number 2
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Rev Med MD 2012; 3.4 (2)
Meconium Peritonitis. Primary Anastomosis or Diversion and Deferred Anastomosis?
Santana-Ortiz R, Zúñiga-Morán A, Aguirre-Jáuregui Ó, Duque-Zepeda F, Chimán-Calderón JC, Gutiérrez-Padilla A, Torre-Gutiérrez M
Language: Spanish
References: 16
Page: 58-62
PDF size: 582.11 Kb.
ABSTRACT
Introduction:
The fibroadhesive type of meconium peritonitis is the most severe clinical form of the meconium disease. Diversion vs. resection and
anastomosis (R and A) as initial management of this clinical presentation of the disease can be a complex decision
Objectives:
To present our experience in the management of meconium peritonitis.
Materials and Methods:
A descriptive, retrospective study was designed in which all patients diagnosed with meconium peritonitis in the Pediatric Surgery
Department in Fray Antonio Alcalde Hospital in Guadalajara from January 2002 through September 2012 were included. Variables such as
sex, gestational age, weight at birth, severity of peritonitis, surgical procedure performed (diversion or R and A), clinical progression and age at
the time of the surgery were analyzed. Analysis was performed with central tendency measures.
Results:
In this period of time, a total of eight patients with MP were included in the study, seven of them with the fibroadhesive type and one with
pseudocyst type. Seven of them were operated at an average of 1.5 days of life and one of them at 24 months of age, due to late diagnosis. Five of
the seven fibroadhesive type were clinically severe, in which initial diversion was performed; the remaining cases of mild and moderately severe
fibroadhesive types were treated with R and A, the moderate case posteriorly complicated and required diversion later on. Just one case turned
out positive to the sweat chloride test. One of the patients passed away.
Discussion:
In our revision, the patient with moderately severe fibroadhesive type in which R and A was performed did not have a satisfactory outcome
and required diversion later on. This case, in spite of being one out of eight, suggests that this kind of patients require initial management with
diversion surgery.
REFERENCES
1.- Miyake H, Urushihara N, Fukumoto K, Sugiyama A, Fukuzawa H, Watanabe K, et al. Primar y anastomosis for meconium peritonitis: first choice of treatment. J Pediatr Surg. 2011 Dec;46(12):2327-31.
2.- Foster MA, Nyberg DA, Mahony BS, Mack LA, Marks WM, Raabe RD. Meconium peritonitis: prenatal sonographic findings and their clinical significance. Radiology. 1987 Dec;165(3):661-5.
3.- Nam SH, Kim SC, Kim DY, Kim AR, Kim KS, Pi SY, et al. Experience with meconium peritonitis. J Pediatr Surg. 2007 Nov;42(11):1822-5.
4.- Winfield RD, Beierle EA. Pediatric surgical issues in meconium disease and cystic fibrosis. Surg Clin North Am. 2006 Apr;86(2):317-27, viii-ix.
5.- Casaccia G, Trucchi A, Nahom A, Aite L, Lucidi V, Giorlandino C, et al. The impact of cystic fibrosis on neonatal intestinal obstruction: The need for prenatal/neonatal screening. Pediatr Surg Int. 2003 Apr;19(1-2):75-8.
6.- Karimi A, Gorter RR, Sleeboom C, Kneepkens CM, Heij HA. Issues in the management of simple and complex meconium ileus. Pediatr Surg Int. 2011 Sep;27(9):963-8.
7.- Theron A, Loveland J, Naidoo J, Theron A. Combined oesophageal atresia with upper pouch fistula and meconium peritonitis. Afr J Paediatr Surg. 2012 May-Aug;9(2):152-4.
8.- Chan KL, Tang MH, Tse HY, Tang RY, Tam PK. Meconium peritonitis: Prenatal diagnosis, postnatal management and outcome. Prenat Diagn. 2005 Aug;25(8):676-82.
9.- Kamata S, Nose K, Ishikawa S, Usui N, Sawai T, Kitayama Y, et al. Meconium peritonitis in utero. Pediatr Surg Int. 2000;16(5-6):377-9.
10.- Izumi Y, Sato Y, Kakui K, Tatsumi K, Fujiwara H, Konishi I. Prenatal treatment of meconium peritonitis with urinary trypsin inhibitor. Ultrasound Obstet Gynecol. 2011 Mar;37(3):366-8. doi: 10.1002/uog.8843.
11.- Jawaheer J, Khalil B, Plummer T, Bianchi A, Morecroft J, Rakoczy G, et al. Primary resection and anastomosis for complicated meconium ileus: A safe procedure? Pediatr Surg Int. 2007 Nov;23(11):1091- 3.
12.- Finkel LI, Slovis TL. Meconium peritonitis, intraperitoneal calcifications and cystic fibrosis Pediatr Radiol. 1982;12(2):92-3.
13.- Keckler SJ, St Peter SD, Spilde TL, Tsao K, Ostlie DJ, Holcomb GW 3rd, et al. Current significance of meconium plug syndrome. J Pediatr Surg. 2008 May;43(5):896-8.
14.- Burge D, Drewett M. Meconium plug obstruction Pediatr Surg Int. 2004 Feb;20(2):108-10.
15.- Várkonyi I, Fliegel C, Rösslein R, Jenny P, Ohnacker H. Meconium periorchitis: Case report and Literature Review. Eur J Pediatr Surg. 2000 Dec;10(6):404-7.
16.- Mushtaq I, Wright VM, Drake DP, Mearns MB, Wood CB. Meconium ileus secondary to cystic fibrosis. The East London experience. Pediatr Surg Int. 1998 Jul;13(5-6):365-9.
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