Meconium plug syndrome

Last revised by Joshua Yap on 4 Oct 2023

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. It is also known as small left colon syndrome or functional immaturity of the colon.

May show multiple dilated bowel loops which are a non-specific finding. There may be a caliber change around the splenic flexure.

Contrast enema may demonstrate a small caliber 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.

Usually resolves with time. Initial non-surgical management includes rectal stimulation and contrast enema 3.

On a plain radiograph consider most other causes of bowel obstruction. On a contrast enema consider:

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