Meconium Disease によると思われる腸穿孔例の検討

抄録

We have observed 5 cases of ileal perforation in Premature infants without necrotizing enterocolitis. These 5 cases had inspissated meconium in the distal part of the perforated ileum and no apparent necrotic change was observed around the perforation site. Typical caliber change could be observed in ileum from the distal site of perforation and the entire colon showed the features of unused microcolon. Multiple biopsies of narrow segments and microcolon showed normal sized ganglion cells and their population was also normal. A study of the trypsin activity of meconium in these perforated 5 cases demonstrsted that all patients whose meconium could be collected showed normal trypsin activity. These findings indicate that these 5 ileal perforations occurred due to meconium ileus without mucovicidosis. (Meconium disease) There have been a number of reports which described meconium disease in Japan but no reports of perforation due to meconium disease. Seven out of 25 patients who have been reported in Japanese articles were trested only with Gastrografin irrigation or enema and the remaining patients were treated by surgical ileostomy. The fact that ileal perforation can occurr due to meconium disease and the difficulties of differential diagnosis between meconium disease and aganglionosis of the entire colon indicates that surgical intervention might be the treatment of choice even in patients without perforations.