Meconium ileus

Abstract

In the newborn with bowel obstruction, one must consider meconium ileus, meconium plug syndrome, Hirschsprung disease, ileal atresia, and malrotation with midgut volvulus. Plain radiographs can give clues (large amount of stool in the right lower abdomen) but are often not diagnostic. Meconium ileus is almost always associated with cystic fibrosis. For patients with simple meconium ileus, water-soluble contrast enema is diagnostic and sometimes therapeutic. If the contrast enema fails to relieve the obstruction, laparotomy should be the next step. At laparotomy options include enterostomy with irrigation of the bowel with saline or acetylcysteine and either primary closure or one of several ileostomy constructs that allow postoperative irrigation of the bowel. Complicated meconium ileus includes infants with bowel perforation and meconium peritonitis, most of whom require laparotomy. Patients are best served by a team approach that includes neonatology, gastroenterology, genetics, pulmonology, and pediatric surgery.