T-Tube ileostomy for meconium ileus: Four decades of experience☆
Section snippets
Materials and methods
A database of 448 patients with cystic fibrosis seen at Texas Children's Hospital was used to identify 83 patients (18.5%) who presented with meconium ileus. This database was begun in 1985, but included many cases diagnosed before that time. Therefore, not all data were available on many cases diagnosed before 1985. All available inpatient and outpatient charts of patients with meconium ileus who underwent placement of a T-tube ileostomy were reviewed retrospectively for demographic and
Results
Sixty of the 83 patients (72%) with meconium ileus required surgery for failure of evacuation of meconium after a contrast enema or complications of meconium ileus. Of these 60 patients, 21 (35%) underwent placement of a T-tube ileostomy. Four patients were eliminated from the study because the unavailability of the original medical records. One patient, who underwent surgery at 148 days of age, was eliminated as a meconium ileus equivalent, rather than a true meconium ileus. Of the remaining
Discussion
T-tube ileostomies are placed through an enterotomy at the junction of proximal dilated bowel and small distal ileum, with minimal bowel manipulation (Fig 1).Any meconium that can be easily removed is removed. However, we do not recommend extensive bowel compression to mechanically remove the obstructing meconium. The T-tube, along with the ileum, is secured to the anterior abdominal wall and then brought out through a stab incision in the right
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Cited by (37)
Risk factors for adverse outcome in infancy in meconium ileus cystic fibrosis infants: A multicentre Italian study
2019, Journal of Cystic FibrosisGastrointestinal surgery in cystic fibrosis: A 20-year review
2014, Journal of Pediatric SurgeryCitation Excerpt :Recurrent episodes of DIOS did not predispose to later need for surgery [5/15 (33%) recurrent episodes versus 5/20 (25%) single episode; P = 0.24]. This is the largest UK surgical series investigating the surgical management of MI and appears to be the largest surgical series worldwide of DIOS [9]. Larger series of MI have been reported by centres in North America but encompass a time period when neonatal survival after MI improved from approximately 33% in the 1960s to 77% in the 1980s [10].
Neonatal Bowel Obstruction
2012, Surgical Clinics of North AmericaCitation Excerpt :Occasionally, the meconium is thick enough or requires enough trauma to the bowel that irrigation must be abandoned. An alternative is placement of a T-tube enterostomy, which allows for daily irrigation until clear (as well as radiographic access for contrast studies).96 A variety of enterostomies and stomas were used historically, including the Santulli (distal bowel as the stoma with an end-to-side anastomosis from the proximal bowel), Bishop-Koop (essentially the reverse of the Santulli), or Mikulitz technique (where a double-barreled stoma is created, allowing access to the proximal and distal limbs).97
Meconium Ileus
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and PrintMeconium Ileus
2012, Pediatric SurgeryMeconium Ileus
2006, Pediatric Surgery: Sixth Edition
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Address reprint requests to Mary L. Brandt, MD, Department of Surgery, Baylor College of Medicine, 6621 Fannin M.C. 3-2325, Houston, TX 77030.