Delayed meconium

Question 1

What is meconium ileus?

Answer 1

MECONIUM ILEUS
Patho
- Associated with CF – absence of fetal pancreatic
enzymes limits normal digestive activities in the
intestines
- Meconium clings to intestinal wall and moves with
difficulty

Question 2

What are the clinical manifestations?

Answer 2

1. Fills intestinal canal, concentrated on lower part of abdomen
2. Pattern of congenital intestinal obstruction with or without
   intestinal perforation
3. Persistent vomiting
4. Abdominal distention prominent
5. History of CF in sibling with palpation of doughy or cordlike
   masses of intestines through abdominal wall and from Xray

Question 3

Management

Answer 3

Mgt
1. High Gastrogaffin enema – if unsuccessful laparotomy
performed and ileum opened at the point of greatest
diameter of the impaction

Question 4

What is meconium plug syndrome?

Answer 4

MECONIUM PLUG SYNDROME

• Meconium at lower colon/anorectal with low water
  content causing obstruction
• Transient obstruction of the lower colon and rectum
  due to impacted meconium
• Assoc with inc incidence of Hirschsprung ds
• Risk factors:
  o Maternal diabetes, small L colon syndrome,
  rectal aganglionosis, mom opiate, MgSO4

Question 5

Clinical manifestations of meconium plug syndrome

Answer 5

1. Delayed passage of meconium after 24-36h

Question 6

What are the diagnostics?

Answer 6

Dx
1. Plain abd XR – distended bowel, no air fluid levels, distal
obstruction with absence of air in rectum

1. Verify by contrast enema then do repeated water soluble
   enemas q4-6h
2. If ineffective: acetylcysteine enema – to break down
   meconium plug and eventually pass out meconium
3. Glycerin suppository
4. Rectal irrigation with isotonic saline
5. If abN stool recur, r/o Hirschsprung disease

Question 7

Differentials

Answer 7

Meconium ileus
Hirschsprung disease