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]

  […] a.k.a Meconium plug syndrome, Functional immaturity of the colon Uncommon cause of neonatal intestinal obstruction characterized by an abrupt intestinal caliber transition at or near the splenic flexure and and normal rectum. [radipedia.com]

  References: Failure to pass meconium: diagnosing neonatal intestinal obstruction. Loening-Baucke V. Am Fam Physician. Nov 1999; 60(7): 2043-2050. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Kimura K. Am Fam Physician. [pedclerk.bsd.uchicago.edu]

  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]

• Sepsis

  6 months) (Medical Encyclopedia) Failure to thrive (Medical Encyclopedia) Hemorrhagic disease of the newborn (Medical Encyclopedia) Hyperglycemia - infants (Medical Encyclopedia) Neonatal respiratory distress syndrome (Medical Encyclopedia) Neonatal sepsis [icdlist.com]

  A more common problem is an infant with sepsis or a metabolic disorder who presents with nonobstructive ileus. [emedicine.medscape.com]

  Failure to recognize neonatal bowel obstruction can result in aspiration of vomit, sepsis, mid-gut infarction or enterocolitis. [pedclerk.bsd.uchicago.edu]

  Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2004;89:F289–F292. 22. Shim SY, Kim HS, Kim DH, Kim EK, Son DW, Kim BI, et al. [synapse.koreamed.org]

  Perforated cases may be confused with NEC which is excluded by clinical history, no signs of sepsis, lab signs missing, abdominal signs missing, typical radiological signs missing. [ijponline.biomedcentral.com]

• Congestive Heart Failure

  ’s disease Small left colon syndrome Other causes Narcotics Electrolyte abnormalities; hypermagnesemia, hypokalemia, hypercalcemia Hypothyroidism Sepsis Congestive heart failure Subsequent obstruction with passage of meconium Pyloric Stenosis Meconium [pedclerk.bsd.uchicago.edu]

  Neonatal medical conditions that can be associated with a failure to pass meconium include hypothyroidism, hypercalcemia, hypokalemia, sepsis and congestive heart failure. [aafp.org]

• 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. [msdmanuals.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]

  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]

  Intestinal obstruction with marked abdominal distension This may occur in: ileal atresia Hirschsprung's disease meconium ileus meconium plug syndrome imperforate anus. [www2.health.vic.gov.au]

• 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]

  In 80 per cent of cases the papilla of Vater opens into the proximal duodenum causing the vomiting to be bilious. [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]

  All develop abdominal distension with bilious vomiting or nasogastric aspirates. See Also Hirschsprung [radipedia.com]

• Intestinal Atresia

  No patients were diagnosed with cystic fibrosis, meconium ileus, malrotation, or intestinal atresia. CONCLUSION: Meconium plugs found on contrast enema are associated with a 13% incidence of Hirschsprung's disease in our experience. [ncbi.nlm.nih.gov]

  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]

  Complicated Meconium Ileus Half of all DIOS patients have complications, which may consist of volvulus, intestinal necrosis, intestinal atresia, meconium peritonitis, or bowel perforation. [surgery4children.com]

  Jejuno-ileal Atresia Just like other atresias of the intestinal tract, jejuno-ileal atresia (JIA) is thought to be caused by a prenatal vascular event resulting in ischemic obliteration of the intestinal lumen. [jaocr.org]

  /colon atresia Failure to pass meconium due to failure of intestine recanalization. [wikidoc.org]

• 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]

• Heart Failure

  ’s disease Small left colon syndrome Other causes Narcotics Electrolyte abnormalities; hypermagnesemia, hypokalemia, hypercalcemia Hypothyroidism Sepsis Congestive heart failure Subsequent obstruction with passage of meconium Pyloric Stenosis Meconium [pedclerk.bsd.uchicago.edu]

  Neonatal medical conditions that can be associated with a failure to pass meconium include hypothyroidism, hypercalcemia, hypokalemia, sepsis and congestive heart failure. [aafp.org]

• Erythema

  Presentation of meconium ileus Presentation includes: early marked bowel distension bilious vomiting remarkable abdominal distention, tenderness and/or erythema of the abdominal skin may indicate perforation on rectal examination mucus plugs may be evacuated [www2.health.vic.gov.au]

  Massive distention, abdominal tenderness or abdominal erythema indicates the presence of complications. Rectal examination is often difficult because of the small caliber of the rectum. [aafp.org]

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]

• Hypermagnesemia

  The clinician should also evaluate the presence of predisposing factors of this disease, such as prematurity, cystic fibrosis, hypermagnesemia, Hirschsprung disease, hypotonia, hypothyroidism, and maternal diabetes. [symptoma.com]

  Neonatal hypermagnesemia and the meconium-plug syndrome. N Engl J Med 1972;286:823–825. 15. Hutchinson HT, Nichols MM, Kuhn CR, Vasicka A. Effects of magnesium sulfate on uterine contractility, intrauterine fetus, and infant. [synapse.koreamed.org]

  Duodenal atresia Jejunoileal atresia Malrotation and volvulus Meconium ileus Disorders of the large intestine Meconium plug syndrome Anorectal malformation Hirschsprung’s disease Small left colon syndrome Other causes Narcotics Electrolyte abnormalities; hypermagnesemia [pedclerk.bsd.uchicago.edu]

  More than 50 percent of newborns with small left colon syndrome are infants of mothers who have diabetes or an abnormal glucose tolerance test. 16 Other infants are hypoglycemic or septic and, in others, an association with hypothyroidism, hypermagnesemia [aafp.org]

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]

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]

Surgical treatment of meconium ileus. Am J Surg 1970;119:99-105. 5. Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: A preliminary report. J Pediatr Surg 1969;4:190-7. 6. Lennon J, Cavalera M. [tmj.ro]

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 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]

Provided that these factors are excluded, the long-term prognosis is excellent. [symptoma.com]

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]

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: 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]

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]

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]

[…] 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]

Seattle Children’s is 1 of just 5 hospitals nationwide whose commitment to preventing and relieving kids’ pain has been recognized by ChildKind International. When it comes to your child’s health, experience matters. [seattlechildrens.org]

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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.
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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.