European Paediatric Surgeons' Association Consensus Statement on the Management of Meconium Ileus

Introduction: The management of meconium ileus (MI) has yet to reach a unified consensus among pediatric surgeons, particularly regarding diagnostics and variants, conservative treatment strategies, surgical approaches, and clinical outcomes. This topic was therefore selected for the 2024 Consensus Session of the Annual Congress European Paediatric Surgeons' Association (EUPSA). Methods: A structured literature review was conducted across Cochrane, Medline, and EMBASE databases up to April 2024. Nine pediatric surgeons appointed by the European Paediatric Surgeons' Association (EUPSA) Consensus Committee reviewed the evidence and developed topic-specific recommendations relating to (1) diagnostics and variants, (2) Gastrografin® (Bracco Diagnostics Inc, Monroe Township, NJ) application and outcomes, and (3) surgery-related outcomes. Findings were presented at the 2024 EUPSA Annual Congress, with consensus statements formulated through iterative discussion and refinement, incorporating feedback from congress participants. Results: The consensus addresses antenatal and postnatal diagnosis, differentiation between simple and complex MI, conservative management using contrast enemas, surgical strategies, and short- and long-term outcomes, particularly in relation to cystic fibrosis (CF). Key recommendations include the use of contrast enema as the primary diagnostic modality and first-line treatment in uncomplicated cases, with surgical intervention indicated for complicated MI or failed conservative management. Enterostomy remains a widely used surgical approach, with technique guided by intraoperative findings and patient factors. Recommendations regarding stoma reversal emphasize the role of multidisciplinary assessment and preoperative evaluation including CF workup and confirmation of distal bowel patency. Conclusion: A peer-reviewed consensus statement on the diagnosis and management of MI has been developed, informed by current evidence and expert practice. This statement provides pragmatic guidance in the diagnosis and management of MI, including the role of contrast enema in uncomplicated cases and surgical intervention for complicated disease. It is recognized by the EUPSA as a valuable resource to support pediatric surgeons in clinical decision-making for this pathology.