Proximal bowel T-tube drainage and local instillation of N-acetyl cysteine: A modified approach to management of meconium ileus

Various surgical procedures are described and practiced for operative management of uncomplicated meconium ileus. In our series, we have tried an approach of minimally invasive procedure to minimize the operative stress in already sick neonates. Ten cases of meconium ileus operated between 01/01/2003 to 21/06/2004 were screened. Three cases presented with complications like peritonitis (2) and volvulus (1) and so were not included in this study. Seven cases were uncomplicated. Out of them three were managed conservatively. Operative management by minilaparotomy - enterotomy and T-tube insertion was done in the remaining four cases, which did not resolve by conservative approach. In this group, patients passed stool by approximately seventh day (range - sixth to eight day). Oral feeds begun on approximately ninth day (range - eighth to tenth day). All four babies survived. This approach of minilaprotomy, T-tube insertion and N acetyl cysteine instillation, could be of significant benefit in an already sick neonate. Also, T- tube helps in post- operative bowel decompression, distal bowel wash and check dye study