Meconium plug syndrome
Meconium plug syndrome refers to a functional colonic obstruction in a newborn due to an obstructing meconium plug. It is usually transient and affects the left colon with meconium plugging the bowel distal to this segment. In this situation, it is also termed the small left colon syndrome.
- may have a higher prevalence with maternal diabetes 2
- Hirschsprung disease in ~15% 3
- may be associated with cystic fibrosis 3
May show multiple dilated bowel loops which are a non-specific finding. There may be a calibre change around the splenic flexure.
Fluoroscopy: contrast enema
Contrast enema may demonstrate a small calibre to the left colon with multiple filling defects within due to retained meconium. The rectum is usually normal in size, unlike Hirschsprung disease. The use of high osmolar ionic contrast media for enema in a neonate or infant is controversial due to the risks associated with fluid shift 4. The enema can be both diagnostic as well as therapeutic and is usually accompanied by the passage of meconium during or after the procedure.
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. On a contrast enema consider:
- 1. Berrocal T, Lamas M, Gutieérrez J et-al. Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19 (5): 1219-36. Radiographics (full text) - Pubmed citation
- 2. Amodio J, Berdon W, Abramson S et-al. Microcolon of prematurity: a form of functional obstruction. AJR Am J Roentgenol. 1986;146 (2): 239-44. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Keckler SJ, St Peter SD, Spilde TL et-al. Current significance of meconium plug syndrome. J. Pediatr. Surg. 2008;43 (5): 896-8. doi:10.1016/j.jpedsurg.2007.12.035 - Free text at pubmed - Pubmed citation
- 4. Walker-Smith JA. Diseases of the Small Intestine in Childhood: Third Edition. Butterworth-Heinemann. ISBN:1483128709. Read it at Google Books - Find it at Amazon