T-Tube ileostomy for meconium ileus: Four decades of experience

Presented at the 30th Annual Meeting of the American Pediatric Surgical Association, Rancho Mirage, California, May 16-19, 1999.
https://doi.org/10.1016/S0022-3468(00)90038-1Get rights and content

Abstract

Background/Purpose: The T-tube ileostomy was first used at Texas Children's Hospital in 1959. The purpose of this study is to update the experience since the initial report of this technique in 1981. Methods: A database of 448 patients with cystic fibrosis (CF) seen in the authors' institution was used to identify 83 patients (18.5%) who presented with meconium ileus. The clinic and hospital charts of these patients were reviewed retrospectively to identify patients who had undergone placement of a T-tube ileostomy. Results: Surgery was performed in 60 of 83 patients for complications of meconium ileus or failure to evacuate the meconium after a contrast enema. Of these patients, 21 of 60 (35%) underwent placement of a T-tube ileostomy. An additional 8 patients were identified who underwent placement of a T-tube ileostomy but were not included in the CF database, for a total of 29 patients who have been treated with T-tube ileostomy since 1959 at Texas Children's Hospital. Five patients were excluded from analysis because of insufficient data or misdiagnosis. One of the 24 patients in the series died of complications of prematurity. A total of 20 of 23 patients had resolution of their meconium ileus after T-tube irrigation with n-acetylcysteine or pancreatic enzymes. Three patients required additional surgery to relieve persistent bowel obstruction. All patients had the T-tube removed within the first 8 weeks after surgery. Two patients required subsequent repair of an incisional hernia. There were otherwise no complications of this procedure, with an average follow-up of 11.5 years. Conclusion: In patients with uncomplicated meconium ileus unrelieved by contrast enema, the T-tube ileostomy is an effective and safe treatment. J Pediatr Surg 35:349-352. Copyright © 2000 by W.B. Saunders Company.

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).

. Intraoperative placement of the T-tube ileostomy.

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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Address reprint requests to Mary L. Brandt, MD, Department of Surgery, Baylor College of Medicine, 6621 Fannin M.C. 3-2325, Houston, TX 77030.

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