Babies with meconium ileus need to be seen by a surgeon. The surgeon will check for signs of more complex problems. Surgeons can sometimes clear meconium ileus with an enema. Most babies need a surgery to clear the blockage. Those with more complex problems — like a hole in the intestine (perforation) — will need surgery to get the meconium out and to fix the other intestinal problems.
Meconium Ileus Treatment Options
Enemas for meconium ileus
If your baby has only meconium ileus and not a more complex problem, the surgeon will first try to wash out the blockage with an enema. Guided by fluoroscopy, a radiologist and a surgeon will place a tube (catheter) in your baby’s rectum. X-ray dye (dilute contrast) will slowly be put through this tube into your baby’s large intestine (colon). The surgeon may also use warm saline. This may be enough to clear the blockage.
If the entire blockage does not wash out the first time, the surgeon and radiologist may perform enemas again over the next one to two days, depending on how your baby is doing.
If enemas do not work
If enemas do not work, your baby will need surgery to remove the blockage.
At the time of surgery, we give your baby medicine to make them sleep without pain (general anesthesia).
The surgeon makes a cut (incision) near the belly button. There are many ways to take care of meconium ileus. Your surgeon will decide which method is best for your baby while doing the surgery. The surgeon may be able to wash out the meconium. But some babies will need to have a segment of their intestine removed (resection) or to have an ostomy (pronounced OST-uh-mee); these procedures are explained below.
Surgery for complicated meconium ileus
The surgeon may advise going straight to surgery (not trying an enema first) if your baby has a more complex problem, such as perforation. The goals of surgery are to remove the meconium and keep as much healthy intestine as possible.
Your surgeon may do one of many procedures based on your baby’s problem. The surgeon will explain the procedure your baby is likely to need. Sometimes the surgeon does not know which procedure is needed until they start the surgery and check your baby’s intestine.
- Resection. The surgeon removes the segment of intestine that is blocked and any segment that was damaged. (Usually when the intestine is perforated, the surgeon must remove that segment.) If the rest of the intestine is healthy enough, the surgeon sews the two open ends of the intestine back together (primary anastomosis, pronounced an-as-toe-MOE-sis) and closes the incisions. In most cases, the baby needs an ostomy instead.
- The surgeon brings the two open ends of the intestine to the surface of the baby’s belly and attaches them to openings (stoma) made in the wall of the belly. Sometimes only one ostomy is needed. In this case, the surgeon attaches one of the open ends to the side of the other open end. Then the surgeon brings just the remaining open end to the surface of the belly.
- After surgery, the surgeon may try to soften and wash out the blockage with liquid. This depends on how much meconium had to be left in the intestine. Liquid can be put through a tube that passes through your baby’s nose to their stomach (nasogastric tube, or NG tube) or through a tube inserted in your baby’s rectum or ostomy. The surgeon may use medicine called acetylcysteine to help soften and move the meconium.
- A bag can be attached to the ostomy to collect waste from the intestine. If your child needs an ostomy, you will get instructions about how to care for the stoma.
- After the blockage is cleared, the surgeon performs another surgery to close the ostomy and to sew the open ends of the intestine together.
After surgery, your baby will stay in our neonatal intensive care unit (NICU), where they get the high level of care they need. When they’re ready, they move to a regular hospital room and eventually to home.
The length of hospital stay varies for babies who have surgery for meconium ileus. These babies usually stay at least a few weeks and often longer. The time frame depends mostly on how long it takes your baby to start eating again and gaining enough weight.
After surgery, your baby will need feedings through a tube that goes into a large vein (central line). When their intestines start to work, most babies need a tube that passes through the nose or mouth into the stomach (an NG tube or an orogastric tube, OG tube). Some will be able to eat by mouth instead of having an NG or OG tube. Your doctor will talk with you about the feeding method that is best for your baby.
We will give your baby pain medicine to make them comfortable.
The surgeon will stay closely involved with your baby’s care while they are in the hospital. When your baby goes home, the surgeon will schedule a follow-up visit. At the follow-up visit, the surgeon will make sure that the incision is healing and your baby is gaining weight and growing as they should.
If your baby has cystic fibrosis, lung doctors (pulmonologists) who treat this disease will be a part of your baby’s care and will provide long-term follow-up for many years.