MECONIUM PERITONITIS IN NEWBORNS: FEATURES OF DIAGNOSTICS AND SURGICAL TREATMENT

Abstract

The purpose of research - to conduct the analysis of meconium peritonitis treatment outcomes in newborns and develop an optimal algorithm for the diagnosis and treatment strategy. Materials and methods. Based on the results of examination and treatment of 24 newborns with meconium peritonitis (MP), which operated in the pediatric surgery clinic Ivano-Frankivsk National Medical University for the past 12 years. All children operated on in the first days of life. Patients were divided into 2 groups. The first group included 11 patients who were operated in the first period of the study (2002-2008.) The second group - 13 patients operated after 2008. When treating patients of the second group we applied a differentiated approach to the choice of surgical treatment depending on the type of MP. Results and discussion. In 79.2% of patients the cause of MP were congenital defects of intestines (atresia, doubling, volvulus), which complicated by necrosis and perforation. In 3 infants observed volvulus and bowel atresia, 4 children had multiple atresia. Localization of perforation in most patients was at the level of the small intestine, only two children - at the level of the colon, in one case - perforation of the stomach. In the majority of operated newborns was detected fibro-adhesive form of MP, a third of children had diffuse peritonitis and two patients - cystic form of MP. We have used tactics of differentiated approach to surgical treatment MP depending on the type of peritonitis in children of the second group (after 2008). Applied differentiated approach to the treatment of infants with MP allowed improve outcomes in children of the second group. Conclusions. The most common cause of MP in our observations was congenital intestinal obstruction. In most cases congenital intestinal obstruction was the indication for surgery in MP. Results of treatment of children with MP depends on its form and pathology that caused it. The worst outcomes we obtained in fibrous- adhesive form of MP. Applied differentiated approach to the surgical treatment depending 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 of children with MP has its antenatal diagnosis.