Presentation
Abdominal distension.
Patient Data
Marked distention of bowel. The more proximal small bowel appears significantly distended when compared to the more distal small bowel.
A relatively normal caliber rectum is identified. The colon appears small and unused, demonstrating several small filling defects in the sigmoid, proximal transverse and ascending portions. Contrast did opacify the appendix and passed into a normal-appearing non-dilated terminal ileum.
Case Discussion
The findings are most consistent with either meconium ileus or jejunoileal atresia. Meconium ileus might be the favored diagnosis because of the multiple filling defects. However, at surgery, mid/distal ileal atresia was confirmed.
It is important to remember that jejunoileal atresia is an acquired in-utero phenomenon secondary to ischemia/infarction and therefore, depending on when it occurs, meconium may have passed into the colon.
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