- Treatment of meconium peritonitis: problems and ways for their solution
Treatment of meconium peritonitis: problems and ways for their solution
Paediatric Surgery.2017.3(56):61-67; doi 10.15574/PS.2017.56.61
Fofanov O. D., Fofanov V. A., Nykiforuk R. I.
Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
The objective of research – to conduct the analysis of meconium peritonitis treatment outcomes in newborns and develop an optimal algorithm for the diagnosis and treatment strategy.
Material and methods. The work is based on the results of examination and treatment of 28 newborn babies with meconium peritonitis (MP), who were operated in the first days of life in the Clinic of Pediatric Surgery of Ivano-Frankivsk National Medical University. The patients were divided into 2 groups. The first group included 12 patients, who operated in the first study period (2002-2008), the second group – 16 patients, who operated after 2008.
Results. In 78.6% of patients the cause of MP were congenital defects of intestines (atresia, doubling, volvulus), which complicated by necrosis and perforation. In 4 infants volvulus and bowel atresia observed, 5 children had multiple atresias. Localization of perforation in most patients was observed in a small intestine, only in two children – in a colon, and in two cases – in a stomach. In the majority of operated newborns was detected fibro-adhesive form of MP, a third of children had diffuse peritonitis and three patients – cystic form of MP. In patients of the second group we improved surgical treatment, which was based on a differentiated approach to the choice of the method of operation, depending upon the type of MP. Applied differentiated approach to the treatment of infants with MP allowed improving outcomes in children of group II.
Conclusions. The most common cause of MP in our observations was congenital intestinal obstruction that was the indication for surgery. Treatment outcomes in children with MP depend upon its form and pathology that caused it. The worst outcomes we obtained in fibrous-adhesive form of MP. The applied differentiated approach to the surgical treatment based on the form of MP allowed to reduce the incidence of postoperative complications and mortality in operated neonates. Great importance in the improving treatment outcomes in children with MP has its antenatal diagnosis.
Key words: meconium peritonitis, surgical treatment, newborns.
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