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]

• Hoarseness

  […] colon is normal in diameter, ruling out microcolon - Case courtesy of Dr Michael Sargent, Radiopaedia.org, rID 6009 Congenital hypothyroidism Most infants are born asymptomatic. [5] Symptoms, if present, may include, but not limited to: Macroglossia Hoarse [wikidoc.org]

• Vomiting

  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]

  Meconium Plug Syndrome (Differential Diagnosis) 2-day-old girl with vomiting and missing evacuation of meconium. The contrast enema shows a columnar defect reaching from the rectum to the transition of the sigmoid to the colon descendens ! [kco.unibe.ch]

• Abdominal Distension

  Clinical findings Non-passage of stool in the first two days of life, vomiting, abdominal distension. Complications Volvulus, intestinal infarction. [medical-dictionary.thefreedictionary.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]

  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]

  distension Failure to pass meconium within 48 hours Bilious 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) [learningradiology.com]

• Bilious Vomiting

  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]

  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]

• 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]

• Severe Abdominal Pain

  Symptoms include Severe abdominal pain or cramping Vomiting Bloating Loud bowel sounds Swelling of the abdomen Inability to pass gas Constipation A complete intestinal obstruction is a medical emergency. It often requires surgery. [icdlist.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]

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]

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.