After birth, a newborn should discontinue meconium within the first 24-48 hours.
Meconium is the first stool of the newborn and is commonly referred to as child pecking because of its black-greenish color.
Meconium does not actually constitute a proper bowel movement, but is a waste product from dead epithelial cells, bile and swallowed hair and skin cells that have accumulated in the dysfunctional intestine during pregnancy.
The very rare meconium ileus causes intestinal obstruction in the newborn due to thickened and putty-like meconium that clogs and sticks the intestine.
A meconium ileus occurs primarily in patients with cystic fibrosis (cystic fibrosis), but can also occur in other diseases of the newborn.
A very similar clinical picture is the meconium plug syndrome (or pseudomekonium ileus), but newborns with a meconium plug syndrome are healthy in the majority of cases.
Newborns affected by a meconium ileus fall through one missing finish of meconium.
Since the Intestines of the newborn is clogged by the meconium, but the newborn is now clogged by feeding with the Breast milk begins to produce proper bowel movements, the abdomen is increasingly distended by the accumulation of stool and air. This is a common symptom Vomit the fed food, as it is already constipated Intestines can no longer be recorded and processed.
A complication of the meconium ileus is one perforation of the intestine, which “bursts” due to the pressure of the meconium. The result is a dangerous one Meconium peritonitiswho are going through fever, a distended and reddened abdomen and sudden serious illness in the newborn.
A perforated meconium ileus is essential operational are supplied
Almost 10% of newborns with cystic fibrosis (cystic fibrosis) have a meconium ileus after birth, but 90% of newborns with meconium ileus have cystic fibrosis.
Cystic fibrosis is the most common cause of a meconium ileus. In cystic fibrosis, an autosomal recessive genetic mutation on chromosome 7 causes the malfunction of the CFTR chloride transporter.
As a result of this malfunction, the secretion of chloride in most organs (e.g. lungs, intestines, pancreas) is disturbed, which leads to a thickening of these secretions.
Hirschsprung's disease is another cause: in this disease, which is also called congenital aganglionosis, the large intestine is not supplied with nerve cells over a variable distance from the anus.
Due to the lack of innervation of the last section of the intestine, this section is dysfunctional and cannot transport the meconium, which leads to the meconium ileus.
The hypoplasia of the left colon (large intestine) is another common cause of a meconium ileus and describes a functional disorder of the last part of the large intestine, which can be completely cured by repeated injections of contrast medium.
In favorable cases, a problem-free intestinal passage is possible after four to six months.
In 50% of cases, hypoplasia of the left colon is associated with maternal (gestational) diabetes.
Rare causes of a meconium ileus are atresia (congenital obstruction) of the intestine, which can occur at any height.
An underactive thyroid in the newborn can also lead to a meconium ileus due to the lack of or inadequate stimulus from thyroid hormones to control bowel function.
An important differential diagnosis of the real meconium ileus is the so-called meconium plug syndrome, which can occur in newborns with only low intestinal motility (bowel movement) and relatively late feeding. In the affected newborns, the intestine is simply too sluggish to transport the meconium and is only stimulated to be active late due to the late ingestion of food.
Most newborns with meconium plug syndrome are completely healthy, but should still be checked for serious conditions such as Hirschsprung's disease or cystic fibrosis.
If the mother was given magnesium sulfate (in laxatives) or opiates (strong pain relievers) during pregnancy, this can lead to delayed discharge of meconium.
Read more on the topic: Meconium
Cystic fibrosis as a cause of a meconium ileus
Cystic fibrosis is a genetic disease. It is identified by a decreased secretion of individual glands. Due to the malfunction, the secretions in the intestine are much tougher and more slimy than in healthy people. This makes the meconium thick and sticky.
Cystic fibrosis is that most common cause of a meconium ileus and should always be clarified when diagnosing an ileus.
In the case of the meconium ileus, which sits at the transition from the small intestine to the large intestine, the area in front of the intestinal obstruction is the area in front of the intestinal obstruction.
The soap bubble-like pattern is created by mixing air with the viscous meconium and is called the Neuhauser symbol. In most cases no mirror formation can be seen. The large intestine appears very narrow (so-called microcolon).
If fluid levels can be seen in the X-ray, this is an indication of atresia or volvulus (rotation of the intestine on its own axis) and not an indication of a meconium ileus caused by cystic fibrosis.
Peritonitis that existed before the birth can be seen through small calcifications on the X-ray.
X-ray as a diagnostic tool
Can be diagnosed Meconium ileus on an x-ray. For this purpose a Absorption of the intestine prepared. Can be seen on this fluid-filled intestinal loops, which are more voluminous than in healthy newborns.
If a meconium ileus is found in a newborn, a gastrografin enema under X-ray examination is performed in patients with a good fluid balance.
Gastrografin is a contrast medium used to visualize the gastrointestinal tract, which is used to better monitor the procedure.
The enema stretches the clogged intestinal section, which allows the meconium to detach from the intestinal wall. If the enema is moving meconium out of the intestine, the enemas should be continued to move more meconium out of the intestine. It may take several enemas over several days to loosen the ileus and completely remove the meconium, but Gastrografin enemas are successful in about 50% of cases of uncomplicated meconium ileus without perforation or other complications.
Possible complications of a Gastrografin enema are perforations of the intestine, which must be treated surgically. If the gastrografin enema does not succeed in removing sufficient meconium from the intestine, the meconium must be removed in an operation. In the case of an uncomplicated meconium ileus, a small incision in the affected intestinal section with subsequent removal and rinsing of the viscous meconium is sufficient.
An artificial anus must rarely be placed temporarily, which can be relocated back after a while.
More about this topic can be found: OP of an intestinal obstruction
In the case of a complicated meconium ileus, it is usually necessary to remove parts of the intestine and sew both ends together again. After such an operation, the newborn must be looked after in the intensive care unit for some time and receive parenteral nutrition via the vein for the first time until the bowel function has normalized.
90% of newborns with meconium ileus are on Cystic fibrosis becomes ill, so that after removal of the meconium through enema or surgery an examination for cystic fibrosis by the so-called Sweat test should be carried out.
The cystic fibrosis is with an incidence of 1:2.000 the most common congenital severe metabolic disorder and is not curable. In addition, newborns with a meconium ileus should be screened for Hirschsprung's disease.
The prognosis of the meconium plug syndrome or the pseudomeconium ileus is very good, further ileus episodes almost never occur.