Management of Meconium Ileus: 5 years' experience at Dhaka Shishu (Children) Hospital

  • Kazi Md Noor ul Ferdous Assistant Professor, Dept. of Neonatal Surgery, Division of Pediatric Surgery, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka
  • Md Samiul Hasan Registrar, Dept. of Minimally Invasive Surgery, Division of Pediatric Surgery Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka
  • Kh Ahsanul Kabir Registrar, Dept. of Neonatal Surgery, Division of Pediatric Surgery Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka
  • M Kabirul Islam Professor and Head Dept. of Neonatal Surgery, Division of Pediatric Surgery Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka
  • Tahmina Banu Professor and Chief Executive Officer Chittagong Research Institute for Children Surgery (CRICS), Chittagong
Keywords: Meconium ileus; Bishop Koop ileostomy; T tube ileostomy; Mikulicz ileostomy

Abstract

Background : Meconium ileus (MI) is one of the common cause of intestinal obstruction in neonate. It can be present with various complications (about 50%) like volvulus, atresia, and gangrene of the gut, perforation and meconium cyst.

Objective : This study aimed to compare various surgical procedures used in the treatment of meconium ileus and to assess their efficacy regarding survival and complications in our center.

Methods : This retrospective study was done to all cases of meconium ileus admitted in the Department of neonatal surgery of Dhaka Shishu (Children) Hospital during the past 5 years (2011 to2016). The medical records of all patients with meconium ileus were studied. The surgical procedures were Mikulicz procedure, Bishop-Koop procedure done in case of complicated cases and Mikulicz procedure, Bishop-Koop and T tube ileostomy done in uncomplicated cases. Outcomes were compared between complicated and uncomplicated group and between the surgical procedures.

Results : Total patients were 224. Among them 8 were excluded due to incomplete data. The mean age was 3.23 days. Twenty four neonates were preterm. Fifty-two percent were uncomplicatedMI and 48.15% were complicated. Among 112 uncomplicated cases, Mikulicz procedure done in 33 cases, Bishop-Koop procedure done in 37 cases and rest were treated by T tube ileostomy procedures. Among 104 cases of complicated meconium ileus, Mikulicz procedure done in 75 cases and 42 cases were treated by Bishop-Koop stoma. Predominant complications in Mikulicz procedures were high output fistula (67.6%), sepsis (34.84%) and skin excoriation (58.33%), while in Bishop-Koop procedure were sepsis (59.25%), anastomotic leak and reoperation (25.75%). In T tube ileostomy, complications were intra-peritoneal leak with reoperation and sepsis (9.52%). Twenty five (11.6%) stoma prolapse were found in Mikulicz ileostomy. The overall mortality of meconium ileus was 36.6%, in simple MI 23 out of 112 and in complicated MI 56 out of 104. This difference was significant.

Conclusion : Considering the study result we concluded that complications occur more frequently in Mikulicz procedure and it is significantly associated with mortality, Bishop- Koop ileostomy can be considered but anastomotic leak is still an important complication of this procedure. In uncomplicated cases T tube ileostomy found as the best option.

Northern International Medical College Journal Vol.10(1) Jul 2018: 326-329

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Author Biographies

Kazi Md Noor ul Ferdous, Assistant Professor, Dept. of Neonatal Surgery, Division of Pediatric Surgery, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka

Dept. of Neonatal Surgery

Md Samiul Hasan, Registrar, Dept. of Minimally Invasive Surgery, Division of Pediatric Surgery Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka

Dept. of Minimally Invasive Surgery

Kh Ahsanul Kabir, Registrar, Dept. of Neonatal Surgery, Division of Pediatric Surgery Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka

Dept. of Neonatal Surgery

M Kabirul Islam, Professor and Head Dept. of Neonatal Surgery, Division of Pediatric Surgery Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka

Dept. of Neonatal Surgery

Published
2019-01-10
How to Cite
Ferdous, K., Hasan, M. S., Kabir, K. A., Islam, M. K., & Banu, T. (2019). Management of Meconium Ileus: 5 years’ experience at Dhaka Shishu (Children) Hospital. Northern International Medical College Journal, 10(1), 326-329. https://doi.org/10.3329/nimcj.v10i1.39314
Section
Original Articles