Vol.33 No.1 2017

Special Articles

New protocol for resolution of meconium related ileus (MRI)

Saori Nakahara
Department of Pediatric Surgery, Japanese Red Cross Medical Center

@Meconium related ileus (MRI) is an entity of bowel obstruction described by Kubota 1995 that mainly occurs in extremely low-birth weight (ELBW) and very low-birth weight (VLBW) infants. To resolve the obstruction conservatively, application of Gastrografin® enema has been reported effective and successful to some extent. But the safest and most effective protocol of Gastrografin® enema has not been established yet. In 2014, we reported a new method that monitors the abdominal pressure during the enema. Aiming not to exceed 50 cm H2O, all patients but two who had Hirschsprung’s disease or ileal volvulus were cured conservatively within 10 days.
@In this paper, we reported another improvement taking advantage of use of a flat panel detector for direct digital radiography which enables detection of more than 200 pictures with a single cassette continuously and visualization only 1 second after shooting. In this way we can see the point of reaching Gastrografin®, and the extent of colon dilatation in real time. Now we can perform Gastrografin® enema without changing the cassette, stopping the maneuver, waiting for developing, and stress of iatrogenic perforation.
@Our new protocol of Gastrografin® enema using monitoring of the abdominal pressure and a new X-ray device will be helpful for resolution of MRI.

KeywordsFMeconium related ileus (MRI), Gastrographin enema, Extreme low birth-weight infant