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Meconium ileus - Coggle Diagram

- - - - Serum chloride > 60 mmol/L
      - gene mutation analysis
      - immmunoreactive trypsinogen
  - - - Dilated loops of bowel with "soap-bubble" or "ground glass" appearance
      - Calcifications in meconium peritonitis
      - no or few air fluid level
    - - Micro-colon with inspissated meconium + small pelets
- - - - Relieves abdominal distention and prevents aspiration.
    - - Cephalosporin and aminoglycosides to prevent infection.
    - - Stabilizes the patient's overall condition before surgery.
  - - - Medical treatment of choice for uncomplicated MI.
      - Water-soluble and hyper-/iso-osmolar contrast
        
        Evacuation under fluoroscopic control.
        
        Gentle and progressive increase in intraluminal pressure to avoid unexpected colon rupture.
        
        Success rate: 60-70% in simple cases with a bowel perforation rate of ~3%.
  - - - Simple MI not responding to conservative treatment.
      - Complicated cases.
    - - Laparotomy via right transverse supra-umbilical incision.
      - Ileotomy and catheter passage
        
        Proximal to inspissated meconium.
        
        Use of N-acetylcysteine in normal saline.
        
        Massage to break up the obstruction.
      - Options after ileotomy
        
        Simple closure
        
        Double-barreled ileostomy.
      - In complicated cases
        
        Resection of ischemic bowel, cyst, atretic segment, etc.
        
        Diverting stoma or primary anastomosis depending on the situation.
- - - - Abdominal distension
        
        Neonates often present with abdominal distention at birth due to distal small bowel obstruction.
        
        Unique to MI, as it is the only variety of neonatal intestinal obstruction causing abdominal distention before the neonate swallows air.
      - Late onset bilious vomiting
      - Non-passage of meconium
      - Characteristic inspissated meconium
        
        Meconium, thick and dehydrated, is evacuated after enema or found during surgery.
  - - - In-utero perforation and meconium peritonitis and cyst formation
        
        Palpable abdominal mass
        
        Discoloration of the abdominal wall
        
        Signs of peritoneal irritation (e.g., distension, tenderness, abdominal wall edema, erythema)
      - Secondary intestinal atresia
      - Volvulus