A water-soluble contrast agent applied in a neonate with cystic fibrosis-related meconium ileus: a case report

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Abstract

Meconium ileus presents a serious challenge in the newborn period, requiring timely diagnosis and effective management. New conservative curative modalities can improve outcomes and reduce the need for surgical interventions, especially in newborns.

The article discusses a case of preterm newborn boy with meconium ileus diagnosed on the second day of his life. Water-soluble contrast on resistant starch and iopromide could resolve intestinal obstruction without any surgical intervention. Contrast passage lasted for 24 hours and was followed by spontaneous stool. No electrolyte disorders were detected during the manipulation. Enteral insufficiency was eliminated, and the child was discharged home on the 14th day of his life with positive weight dynamics. Irrigography showed no evidence of Hirschprung’s disease. Genetic examination confirmed that the child was a carrier of cystic fibrosis gene.

Thus, water-soluble contrast with resistant starch is a new approach that can potentially improve the effectiveness of conservative treatment of meconium ileus in newborns. Resistant starch reduces systemic iodine exposure and improves bowel motility. The discussed technique is a valuable addition to the existing approaches in treating meconial ileus which allows to avoid surgical intervention and its associated risks. Further research and clinical experience will define optimal protocols on the application of the described technique and its place in the algorithm of diagnosis and treatment of meconium ileus in newborns.

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About the authors

Fedor M. Shvalev

Ural State Medical University; Regional Children Hospital, Ekaterinburg

Author for correspondence.
Email: aesthetic@list.ru
ORCID iD: 0009-0005-0709-2213
SPIN-code: 6488-3900
Russian Federation, Ekaterinburg; Ekaterinburg

Natalya A. Tsap

Ural State Medical University; Regional Children Hospital, Ekaterinburg

Email: tsapna-ekat@rambler.ru
ORCID iD: 0000-0001-9050-3629
SPIN-code: 7466-8731

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Ekaterinburg; Ekaterinburg

Vladislav B. Chudakov

Regional Children Hospital, Ekaterinburg

Email: vb.chudakov@gmail.com
ORCID iD: 0000-0002-4306-1378
SPIN-code: 1789-4251
Russian Federation, Ekaterinburg

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2. Fig. 1. Radiological diagnosis of congenital low intestinal obstruction in a neonate with meconium ileus associated with cystic fibrosis: dynamics of radiological examinations. a, оverview radiograph of the abdominal organs on the third day of life (Conclusion: Congenital low intestinal obstruction). b–e, сontrast radiography of the gastrointestinal tract (direct projection) with contrast agent on resistant starch and iopromide: b, on the third day of life, three hours after contract administration (Conclusion: The contrast fills loops of the small intestine. Significant dilation of a small intestine loop); с, on the third day of life, six hours after contract administration (Conclusion: Contrast fills loops of the small intestine. Multiple fluid levels); d, infant C., 4 days old. Contrast radiography of the gastrointestinal tract 24 hours after contract administration (Conclusion: Contrast localized in the projection of both small and large intestine loops); e, Infant C., 4 days old. Contrast radiography of the gastrointestinal tract 36 hours after contrast administration (Conclusion: Uniform intestinal loop pneumatization. The rectum is filled with gas); f, Infant C., 12 days old. Irrigography with a water-soluble contrast agent on resistant starch and iopromide (Conclusion: No pathological narrowings. The contrast reached the terminal ileum).

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