Medline ® Abstracts for References 30-32
of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'
New strategies in nonoperative management of meconium ileus.
Burke MS, Ragi JM, Karamanoukian HL, Kotter M, Brisseau GF, Borowitz DS, Ryan ME, Irish MS, Glick PL
J Pediatr Surg. 2002;37(5):760.
PURPOSE: The aim of this study was to develop new nonoperative strategies for the management of meconium ileus in an attempt to improve on the current unacceptable failure rate.
METHODS: Mice were constipated with subcutaneous morphine injection. Each then received an enema solution (perflubron, surfactant, Tween-80, Gastrografin, Golytely, DNase, N-Acetylcysteine, Viokase, or normal saline). After the enema solution was administered, stool output was quantitated. Histologic examination of the intestines was performed on a second group of mice that also received enemas. Finally, viscosity measurements were taken of human meconium at baseline and after variable incubation periods with each test solution.
RESULTS: For relieving constipation in vivo, Gastrografin enema was most efficacious. All agents were equally benign to the intestinal mucosa. In vitro, only 4% N-Acetylcysteine and perflubron were less effective at decreasing meconium viscosity than normal saline at T = 0 hours, with N-Acetylcysteine producing greater reduction in viscosity than normal saline at T = 6 hours.
CONCLUSIONS: Our results show that surfactant and Gastrografin are the most effective for the in vivo relief of constipation. This is accomplished without mucosal damage. These agents also significantly reduce viscosity in vitro, and we speculate that they may be beneficial in relieving constipation caused by meconium ileus in cystic fibrosis patients.
Buffalo, New York, USA.
Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology.
Kao SC, Franken EA Jr
Pediatr Radiol. 1995;25(2):97.
To determine the practice pattern regarding nonoperative treatment of simple meconium ileus, a survey was sent to directors of 66 pediatric radiology departments in the USA and Canada. Thirty-nine responses were received reporting 1,236 patients. A wide variation of enema techniques and contrast media were used. While the success rate did not correlate with osmolality, mode of administration, catheter size, or perforation rate, there was a significantly higher overall success rate with the use of Gastrografin versus non-Gastrografin (p<0.00076) and the use of additives such as Tween-80 and Mucomyst versus techniques without additives (p<0.00001). Perforation did not correlate with success rate, osmolality, or type of contrast medium. The only two instances of rectal perforations were associated with the use of balloon-tip catheter.
Department of Radiology, University of Iowa College of Medicine, Iowa City, USA.
Tween 80/diatrizoate enemas in bowel obstruction.
Wood BP, Katzberg RW
AJR Am J Roentgenol. 1978;130(4):747.
Although successful treatment of meconium ileus with Gastrografin enema has been attributed to the hypertonicity of this material, Tween 80, present in a 0.75% concentration, may be its most effective component. Tween 80 acts as a surface-active substance and stool emulsifier. An enema solution of 1%-2% Tween 80 and isotonic sodium diatrizoate has been effective in the relief of meconium or fecal mass obstruction in infants and children.