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Objective@#To improve the accuracy of the diagnosis and decrease the unnecessary surgical exploration in neonates with simple meconium ileus (SMI) by analyzing clinical characteristics of SMI.@*Methods@#Forty-five neonates identified as SMI from January 2008 to May 2018 had been collected, and the data of pregnancy, birth weight, treatments, hospital stay and results of follow-up were included.The patients were divided into 2 groups: surgical group and non-surgical group.The surgical group underwent enterostomy at the end of ileum, meanwhile, the intestinal wall was biopsied for checking the existence of ganglion cells.All the neonates in the surgical group underwent stoma closure in 3 to 6 months postoperatively.The non-surgical group received fasting, intravenous nutritional support, enema with amiotol diluted into 11 or injected into the stomach by the gastric tube.They all received enema with warm salt (9 g/L) 1-2 times per day.Once the abdominal dilation was mitigated and autonomous defecation obtained, the neonates gradually began the oral feeding and weaned from the total parenteral nutrition(TPN). The 45 neonates were also divided into earlier group (from January 2008 to May 2013) and later group (from June 2013 to May 2018) according to the time of diagnosis.The relationships between the SMI treatment choice and the pregnancy, birth weight and time of diagnosis were analyzed.@*Results@#No cystic fibrosis lesions were found in 45 neonates, of which 21 and 24 neonates were in non-surgical group and surgical group, respectively.In the operation, the intestine presented similar anatomy to the total Hirschsprung′s disease.However, the ganglion was observed not only in the stricture, transitional and dilated zone of ileum, but also in the colon.There were no significant differences in the pregnancy and birth weight in both groups(P>0.05), but there was significant difference in the duration of hospitalization [(21.19±5.13) d vs.(12.29±3.85) d, P=0.000]. There were complications in those patients who had undergone enterostomy, including wound infection (2 cases), prolapse of stoma (2 cases), water and electrolyte disorders (2 cases), malnutrition (21 cases). After the stoma closure, no signs of ganglion cell dysplasia were found in follow-up.In non-surgical group, there were 20 pre-term reonates and 1 full-term neonate, respectively.In surgical group, there were 22 pre-term reonates and 2 full-term neonate, respectively.Neither pregnancy nor birth weight was related to the choice of treatment (P>0.05), but the time when to be admitted was highly related to the choice of treatment (P<0.05).@*Conclusions@#It is not rare for the occurrence of SMI in neonates in China, especially in preterm neonates.Amiotol may have effects not only on diagnosis but also on treatment of SMI, which can be applied repeatedly.Non-surgical treatment can help most of the neonates with SMI to avoid surgical exploration.Enhancing apprehension about the SMI may have great advantages to decrease the rate of unnecessary laparotomy.
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Objective To improve the accuracy of the diagnosis and decrease the unnecessary surgical explo_ration in neonates with simple meconium ileus(SmI)by analyzing clinical characteristics of SmI. Methods Forty_five neonates identified as SmI from January 2008 to may 2018 had been collected,and the data of pregnancy,birth weight,treatments,hospital stay and results of follow_up were included. The patients were divided into 2 groups:surgi_cal group and non_surgical group. The surgical group underwent enterostomy at the end of ileum,meanwhile,the intes_tinal wall was biopsied for checking the existence of ganglion cells. All the neonates in the surgical group underwent sto_ma closure in 3 to 6 months postoperatively. The non_surgical group received fasting,intravenous nutritional support, enema with amiotol diluted into 1: 1 or injected into the stomach by the gastric tube. They all received enema with warm salt(9 g/L)1_2 times per day. Once the abdominal dilation was mitigated and autonomous defecation obtained, the neonates gradually began the oral feeding and weaned from the total parenteral nutrition( TPN). The 45 neonates were also divided into earlier group(from January 2008 to may 2013)and later group(from June 2013 to may 2018) according to the time of diagnosis. The relationships between the SmI treatment choice and the pregnancy,birth weight and time of diagnosis were analyzed. Results No cystic fibrosis lesions were found in 45 neonates,of which 21 and 24 neonates were in non_surgical group and surgical group,respectively. In the operation,the intestine presented similar anatomy to the total Hirschsprung＇s disease. However,the ganglion was observed not only in the stricture,transitional and dilated zone of ileum,but also in the colon. There were no significant differences in the pregnancy and birth weight in both groups(P>0. 05),but there was significant difference in the duration of hospitalization[(21. 19 ± 5. 13)d υs. (12. 29 ± 3. 85)d,P=0. 000]. There were complications in those patients who had undergone enterostomy,including wound infection(2 cases),prolapse of stoma(2 cases),water and electrolyte disorders(2 cases),malnutrition(21 cases). After the stoma closure,no signs of ganglion cell dysplasia were found in follow_up. In non_surgical group, there were 20 pre_term reonates and 1 full_term neonate,respectively. In surgical group,there were 22 pre_term reonates and 2 full_term neonate,respectively. Neither pregnancy nor birth weight was related to the choice of treat_ment(P>0. 05 ),but the time when to be admitted was highly related to the choice of treatment( P <0. 05 ). Conclusions It is not rare for the occurrence of SmI in neonates in China,especially in preterm neonates. Amiotol may have effects not only on diagnosis but also on treatment of SmI,which can be applied repeatedly. Non_surgical treat_ment can help most of the neonates with SmI to avoid surgical exploration. Enhancing apprehension about the SmI may have great advantages to decrease the rate of unnecessary laparotomy.
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Objective To investigate the role of ileocecal valve in children patients with intussus-ceptions by colonoscopy after pneumatic air enema reduction. Methods A total of 106 intussusceptions chil dren patients, who recovered with pneumatic air edema reduction, were recruited to the study. They underwent colonoscopy within 12 hours after reduction. The control group was composed of 103 children patients with both diarrhea and hematochezia. There was no significant difference in age, sex or weight between the two groups.Colonoscopic findings were recorded in terms of slack, swelling, prolapsus, lymphoid hyperplasia and mucosal lesions in ileocecal valve. Results In patients with intussusceptions, the rates of ileocecal valve slack, swelling including prolapsus, lymphoid hyperplasia and mucosal lesions were 61.3%, 33. 9%, 100. 0% and 31.1%, respectively, which were significantly different with those of the control group (P ＞ 0. 05 ). When further divided intussusceptions patients into groups with age more than 1 yr or less, significant differences were also observed in regarding of these features. Conclusion There is a close relationship between morphological and functional changes in ileocecal valve and intussusceptions in children. Ileocolic intussusceptions in patients younger than 1yr is more likely to be due to slack of ileocecal valve, while that in patients older than 1yr is mainly due to swelling or prolapse of ileocecal valve, represented by ileocecal intussuception.