Presentation
1-day-old term baby with failure to pass meconium and abdominal distension.
Patient Data
Multiple loops of distended gas-filled bowel. No dominant dilated loop. No perforation. No gas within the rectum.
Water-soluble contrast instilled via a rectal feeding-tube. Contrast opacifies a colon of normal diameter. Multiple filling-defects. No microcolon. Normal terminal ileum. Appearances are most in keeping with meconium plug syndrome.
Case Discussion
The differential of failure to pass meconium can often be diagnosed with a contrast-enema. Normal colonic caliber narrows the diagnosis and the presence of filling defects points to a meconium plug syndrome.
After two contrast enemas, on successive days, all filling defects were removed and the baby started to pass stool normally. The abdominal distension reduced and they were discharged with no subsequent signs or symptoms.
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