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Meconium Plug Syndrome

Meconium Obstruction

Meconium plug syndrome is a transient functional abnormality of the newborn's digestive system which consists of the delayed passage of the meconium (beyond 24-48 hours), abdominal distension, vomiting, and dilatation of the left colon. The disease is diagnosed and treated by radiographic contrast enema, but Hirschsprung disease and cystic fibrosis should be excluded.


Presentation

Meconium plug syndrome, much like Hirschsprung disease, intestinal and anal atresia, anal stenosis, and intestinal malrotation, presents with progressive abdominal distension, an absence of meconium elimination, and bilious vomiting [1]. In this disease, the probable causes are intestinal hypomotility and increased consistency of fecal matter that adheres to the colonic wall and becomes immobile [2]. Abdominal inspection and palpation reveal dilated bowel loops.

The clinician should also evaluate the presence of predisposing factors of this disease, such as prematurity [3], cystic fibrosis [4], hypermagnesemia, Hirschsprung disease [5], hypotonia, hypothyroidism, and maternal diabetes. Provided that these factors are excluded, the long-term prognosis is excellent.

Neonatal Intestinal Obstruction
  • Abstract A mass of inspissated meconium in the distal colon or rectum is a relatively common cause of neonatal intestinal obstruction. The meconium-plug syndrome is unrelated to cystic fibrosis and meconium ileus.[ncbi.nlm.nih.gov]
  • Documentation: The meconium plug syndrome is a common cause of neonatal intestinal obstruction with a failure to pass meconium. It may occur by itself or it may occur in conjunction with other bowel disorders.[meducator3.net]
  • Failure to pass meconium: diagnosing neonatal intestinal obstruction. Am Fam Physician 1999;60:2043–2050. 6. Burke MS, Ragi JM, Karamanoukian HL, Kotter M, Brisseau GF, Borowitz DS, et al. New strategies in nonoperative management of meconium ileus.[synapse.koreamed.org]
  • intestinal obstructions classifiable to P76.- obstruction of duodenum ( K31.5 ) postprocedural intestinal obstruction ( K91.3- ) stenosis of anus or rectum ( K62.4 ) ICD-10-CM Diagnosis Code Q41 Congenital absence, atresia and stenosis of small intestine[icd10data.com]
  • Another rare cause of neonatal intestinal obstruction is the megacystis-microcolon-intestinal hypoperistalsis syndrome. 22 In this disorder, the small bowel is dilated and shortened, and the colon is a microcolon ( Figure 7 ) .[aafp.org]
Pathologist
  • The pathologist examines the specimens for presence of normal nerves. Risks of suction rectal biopsy include bleeding, getting a hole in the intestine and not obtaining adequate specimens. Home Care (“What do I need to do once my child goes home?”)[eapsa.org]
Splenectomy
  • Hone and expand your surgical skills by watching videos of minimally invasive procedures for recto urethral fistula, biliary atresia, laparoscopic splenectomy, uterine horn, and more.[books.google.de]
Arachnodactyly
  • Page 896 - Genetic linkage of the Marfan syndrome, ectopia lentis, and congenital contractural arachnodactyly to the fibrillin genes on chromosomes 15 and 5. N Engl J Med 1992;326:905-909. ‎[books.google.com]
Vomiting
  • Meconium plug syndrome is a transient functional abnormality of the newborn's digestive system which consists of the delayed passage of the meconium (beyond 24-48 hours), abdominal distension, vomiting, and dilatation of the left colon.[symptoma.com]
  • Clinical findings Non-passage of stool in the first two days of life, vomiting, abdominal distension. Complications Volvulus, intestinal infarction.[medical-dictionary.thefreedictionary.com]
  • What to call the doctor for: Call for persistent vomiting, swelling of the belly or failure to pass stool.[eapsa.org]
  • However, newborns with meconium plug syndrome do not pass meconium within the first day or two and also have symptoms of intestinal blockage, including vomiting and abdominal swelling.[merckmanuals.com]
  • Keywords Cystic Fibrosis Rectal Biopsy Contrast Enema Intestinal Atresia Bilious Vomiting These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.[link.springer.com]
Abdominal Distension
  • Meconium plug syndrome is a transient functional abnormality of the newborn's digestive system which consists of the delayed passage of the meconium (beyond 24-48 hours), abdominal distension, vomiting, and dilatation of the left colon.[symptoma.com]
  • Therefore, we reviewed our experience with meconium plugs as a cause of abdominal distension to evaluate the associated conditions and incidence of Hirschsprung's disease.[ncbi.nlm.nih.gov]
  • Clinical findings Non-passage of stool in the first two days of life, vomiting, abdominal distension. Complications Volvulus, intestinal infarction.[medical-dictionary.thefreedictionary.com]
  • Typically presents with failure to pass meconium and abdominal distension with or without vomiting.[wikidoc.org]
  • Peer Review Status: Internally Peer Reviewed Clinical Presentation: Generalized abdominal distension, failure to pass meconium, and delayed onset of vomiting.[virtualpediatrichospital.org]
Bilious Vomiting
  • Meconium plug syndrome, much like Hirschsprung disease, intestinal and anal atresia, anal stenosis, and intestinal malrotation, presents with progressive abdominal distension, an absence of meconium elimination, and bilious vomiting.[symptoma.com]
  • Keywords Cystic Fibrosis Rectal Biopsy Contrast Enema Intestinal Atresia Bilious Vomiting These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.[link.springer.com]
  • Clinical and radiologic findings: (1) neonate with evidence of bowel obstruction (1a) failure to pass meconium (1b) abdominal distention (1c) bilious vomiting (2) distended colon with an obstructing filling defect (3) a diagnostic enema results in passage[meducator3.net]
  • vomiting Imaging Findings On conventional radiographs Meconium, being fluid density, is normally invisible on radiographs In meconium ileus, there may be dilated loops of bowel (small bowel) typically without air-fluid levels because of the viscosity[learningradiology.com]
  • Features include the following: Bilious vomiting is the initial symptom and abdominal distention is minimal until a much later stage. Bowel can become strangulated at any time and age.[www2.health.vic.gov.au]
Regurgitation
  • Persistent regurgitation, abdominal distention, and infrequent bowel movements resulted in roentgenographic study with contrast of the upper gastrointestinal tract which was reported as normal.[pediatrics.aappublications.org]
  • 、コードの追加 - - - - newborn P96.1 ----新生児P96.1 参照項目、コードの追加 - rectocele, maternal, in pregnancy or childbirth -直腸脱、母体側、妊娠または出産に伴うもの 参照項目の追加 - - causing obstructed labor, affecting fetus or newborn P03.1 --分娩停止の原因となったもの、胎児または新生児に影響するもの P03.1 参照項目、コードの追加 - regurgitation[mhlw.go.jp]
Nausea
  • For other adverse effects, Haiden et al. [ 29 ] reported a high proportion of NEC stage II (21 vs. 8%), vomiting, nausea and bradycardia in neonates in the Gastrografin group [ 29 ].[karger.com]
Ectopia Lentis
  • Page 896 - Genetic linkage of the Marfan syndrome, ectopia lentis, and congenital contractural arachnodactyly to the fibrillin genes on chromosomes 15 and 5. N Engl J Med 1992;326:905-909. ‎[books.google.com]

Workup

The physician should order plain abdominal radiographs in supine and left lateral decubitus positions, that point out the presence of dilated intestinal loops and an absence of rectal gas. Fluid levels are also absent throughout the small and large bowel. Diagnostic protocol implies that contrast enema is administered afterward. Barium and other contrast agents have been used, but some have been hyperosmolar and caused dehydration [6]. Furthermore, some detergents and wetting additives are toxic and should not be used [7], so clinical judgment is required to determine which contrast agent is most appropriate for the patient. This method reveals a dilated area of the colon and the meconium plug, causing total or partial obstruction and presenting a double-contrast effect [8]. Ribbon-like or sausage shaped filling defects are due to the presence of meconium. The rectum has normal size if Hirschsprung disease is absent. In some cases, the left colon may be constitutionally small, so the investigation will highlight a difference between colon diameters before and after the splenic flexure. Normally, an intestinal loop should not be wider than a lumbar vertebral body. The contrast enema can be performed more than once [9]. If the problem persists after one or two enemas, that should also have a therapeutic effect and lead to prompt meconium elimination, another cause like Hirschsprung disease should be evaluated by rectal-suction biopsy. Hirschsprung disease can be mimicked on radiological films in meconium plug syndrome because the descending colon distal to the plug may be collapsed, therefore a biopsy is highly recommended in this case. Radiological evaluation can also exclude meconium ileus, in which case the appearance is that of a microcolon, but is unable to differentiate between a large bowel and small bowel obstruction (duodenal or jejunoileal atresia, malrotation, volvulus). Differential diagnosis may also be aided by anorectal manometry.

Bowel Distention
  • Abdominal radiographs show signs of lower intestinal obstruction with variable abdominal bowel gas, bowel distention, and air-fluid levels. These radiographic findings are nonspecific; hence, barium enema must be performed.[jaocr.org]

Treatment

  • RESULTS: Approximately 30% of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97% success.[ncbi.nlm.nih.gov]
  • In spite of the risks inherent in the use of Urografin amniography, as well as of amniocentesis, there appear to be a great number of advantages to the treatment of meconium obstruction of the fetus in utero.[ncbi.nlm.nih.gov]
  • Make informed clinical choices for each patient, from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout.[books.google.de]
  • Treatment (“What will be done to make my child better?”) Contrast enema: Contrast enema helps in both the diagnosis and treatment of meconium plugs.[eapsa.org]
  • Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg 1969;4:190–197. 24. Shaw A. Safety of N-acetylcysteine in treatment of meconium obstruction of the newborn. J Pediatr Surg 1969;4:119–125. 25.[synapse.koreamed.org]

Prognosis

  • Provided that these factors are excluded, the long-term prognosis is excellent.[symptoma.com]
  • Treatment and prognosis Usually, resolves with time. Initial nonsurgical management includes rectal stimulation and contrast enema 3 . On a plain radiograph consider most other causes of bowel obstruction .[radiopaedia.org]
  • In certain cases, surgery may have to be performed with the goal of establishing intestinal continuity and preservation of maximal intestinal length. 9 The prognosis for infants with both simple and complicated MI is excellent with reported survival rates[jaocr.org]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Etiology/Pathophysiology: Ganglion cells are present but immature and this causes a functional colonic inertia which leads to a meconium plug forming in the colon, that causes obstruction and a narrowed descending colon.[virtualpediatrichospital.org]
  • Duodenal atresia: The etiology of duodenal atresia is from failure to recanalize the lumen after the solid phase of intestinal development.[pedclerk.bsd.uchicago.edu]
  • Some authors describe 4 types of meconium peritonitis: Adhesive meconium peritonitis Meconium cyst Giant cystic meconium peritonitis Infected meconium peritonitis Bowel perforation is a common etiology in all four of the peritonitis forms.[surgery4children.com]
  • Prenatal and perinatal insults causing microcolon represent myriad of etiologies, which include hypoperfusion, as well as factors associated with dysmotility and stasis.[jaocr.org]

Epidemiology

  • Epidemiology: The underlying cause meconium plugs is largely unknown.[eapsa.org]
  • Epidemiology of congenital innervation defects of the distal colon. Virchows Arch A Pathol Anat Histopathol . 1992;420:171–7. 19. Smith V V.[aafp.org]
Sex distribution
Age distribution

Pathophysiology

  • Etiology/Pathophysiology: Ganglion cells are present but immature and this causes a functional colonic inertia which leads to a meconium plug forming in the colon, that causes obstruction and a narrowed descending colon.[virtualpediatrichospital.org]
  • (This clinical review offers a concise and current summary of the pathophysiology of Hirshsprung’s disease and associated disorders, and it focuses on clinical evaluation, including radiographic and histopathological diagnostic tools.) Langer, JC.[clinicaladvisor.com]
  • A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon. J Pediatr Surg 2012; 47: 772-781. Juang D, Snyder CL. Neonatal bowel obstruction. Surg Clin N Am 2012; 92: 685-711.[jaocr.org]

Prevention

  • - 0% Emergent - ED Care Needed - Preventable/Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis[medicbind.com]
  • How can Hirschsprung disease be prevented? At present, no preventive treatment is available for Hirschsprung disease. Earlier recognition of Hirschsprung disease and its complications, including enterocolitis, is associated with improved outcomes.[clinicaladvisor.com]
  • Prompt recognition associated to an early and "aggressive" conservative management is essential to prevent complications and spare surgical interventions.[ijponline.biomedcentral.com]
  • […] of meconium ileus is not related to the severity of the cystic fibrosis. [11] The obstruction can be relieved in a number of different ways. [12] Meconium ileus should be distinguished from meconium plug syndrome, in which a tenacious mass of mucus prevents[en.wikipedia.org]
  • Al Faleh K, Anabrees J: Probiotics for prevention of necrotizing enterocolitis in preterm infants. Evid Based Child Health 2014;9:584-671. Author Contacts Mangesh Deshmukh, FRACP, MSC St.[karger.com]

References

Article

  1. Dillon PW, Cilley RE. Newborn surgical emergencies. Gastrointestinal anomalies, abdominal wall defects. Pediatr Clin North Am. 1993;40:1289–1314.
  2. Ellis DG, Clatworthy HW. The meconium plug syndrome revisited. J Pediatr Surg. 1966;1:54–61.
  3. Vinograd I, Mogle P, Peleg O, Alpan G, Lernau OZ. Meconium disease in premature infants with very low birth weight. J Pediatr. 1983;103:963–966.
  4. Rosenstein BJ. Cystic fibrosis presenting with the meconium plug syndrome. Am J Dis Child. 1978;132:167–169.
  5. Hen J, Dolan TF, Touloukian RJ. Meconium plug syndrome associated with cystic fibrosis and Hirschsprung’s disease. Pediatrics. 1980;66:466–468.
  6. Kim HS, Je BK, Cha SH, et al. Renal excretion of water-soluble contrast media after enema in the neonatal period. Pediatr Neonatol. 2014;55(4):256-61.
  7. Carroll AG, Kavanagh RG, Ni Leidhin C, et al. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants: A Critically Appraised Topic. Acad Radiol. 2016;23 (5):559-568.
  8. Burge D, Drewett M. Meconium plug obstruction. Pediatr Surg International. 2004;20(2):108-110.
  9. Cho HH, Cheon JE, Choi YH, et al. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success. Eur J Radiol. 2015; 84 10):2024-2031.

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Last updated: 2019-06-28 10:43