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 login to view 3 more bullets Associated conditions login to view 2 more bullets Risk factors login to view 1 more bullet Presentation Symptoms login to view 2 more bullets Physical exam login to view 2 more bullets Evaluation Abdominal radiograph login to view 2 more bullets Contrast enema with water-soluble contrast (Gastrografin, barium, etc.) login to view 3 more bullets 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 login to view 3 more bullets Complications login to view 3 more bullets