Updated: 3/25/2017

Meconium Ileus

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Snapshot
  • A neonate is born without any complications to a 24-year-old mother who received no prenatal care or screening. At 2 days of life, the male newborn becomes irritable and inconsolable. He is noted to have abdominal distension. On review of his medical chart, his physician realizes that he failed to pass any meconium since being born. An abdominal radiograph reveals no perforation. A follow-up barium enema shows microcolon and terminal ileum with meconium.
Introduction
  • Intestinal obstruction caused by meconium in bowel lumen
  • Classically associated with cystic fibrosis (CF)
  • Pathogenesis
    • secretion of hyperviscous mucus by intestinal glands
    • thick mucus in bowel lumen causes obstruction
    • narrowing of distal small intestine and colon
  • Associated conditions
    • earliest manifestation of cystic CF
    • up to 20% of patients with CF
  • Risk factors
    • family history of CF or meconium ileus
Presentation
  • Symptoms
    • failure to pass meconium rectally
    • bilious vomiting
  • Physical exam
    • abdominal distension
    • palpable bowel loops
Evaluation
  • Abdominal radiograph
    • dilated small intestinal loops proximal to obstruction
    • narrowed loops distal to obstruction
  • Contrast enema with water-soluble contrast (Gastrografin, barium, etc.)
    • diagnosis and treatment 
    • most definitive diagnosis
    • microcolon from non-use
  • Sweat test after 48 hours of age for CF diagnosis 
Differential Diagnosis
  • Intestinal atresia
  • Hirschsprung disease
  • Volvulus
Treatment
  • Water-soluble contrast enema in simple cases
  • Surgery in complicated cases or those that fail the enema
  • Supportive care
  • Oral gastric tube
Prognosis, Prevention, and Complications
  • Prognosis
    • low risk of mortality with treatment
    • likely to develop other conditions in life
      • bowel obstructions
  • Complications
    • intussusception
    • segmental volvulus
    • meconium peritonitis
 

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