MECONINM ILEUS SECONDARY TO CYSTIC-FIBROSIS - THE EAST LONDON EXPERIENCE

Meconium ileus (MI) affects 15% of neonates with cystic fibrosis (CF). The authors reviewed the management and outcome of 51 neonates presen ting to a single institution between 1976 and 1995 with MI secondary t o CF. Clinical presentation included abdominal distension (96%), bilio us vomiting (49%), and delayed passage of meconium (36%), A family his tory of CF was present in 4 cases (8%). Twenty-three neonates presente d with MI and evidence of volvulus, atresia, or perforation (complicat ed MI). Of these, 16 underwent stoma formation, 1 appendicectomy, and 6 resection with primary anastomosis. Twenty-eight neonates presented with uncomplicated MI. Of these, 11 were managed non-operatively by Ga strografin enema (10) or enteral N-acetylcysteine (1). The remainder r equired stoma formation (15) or bowel resection with primary anastomos is (2). Early postoperative complications occurred in 2 neonates (4%). In this hospital the 1-year survival for this condition has increased from 49% (1953-1970) to 98% (1976-1995) irrespective of the surgical procedure performed or the presence of volvulus, atresia, or perforati on. In our experience, bowel resection with primary anastomosis is as safe as stoma formation and is associated with a reduced length of ini tial hospital stay.