Meconium plug syndrome

Case contributed by Dr Jeremy Jones

Presentation

Term baby. Failure to pass meconium. Abdominal distension.

Patient Data

Gender: Male
X-ray

Multiple loops of gas-filled loops of bowel which are predominantly central. Difficult to determine whether it is small or large bowel.

Fluoroscopy

Water-soluble contrast by rectum. Normal rectosigmoid ratio. Filling voids in the sigmoid. Contrast fills proximal colon around to cecum which is of normal caliber. Multiple meconium plugs expelled during the procedure.

Case Discussion

After the water-soluble enema, abdominal distension eased and the baby started to stool normally. They were observed for a further 48 hours and then discharged with no further imaging.

Appearances here are of meconium plug syndrome. This affects the left colon and causes obstruction. The enema is therapeutic as well as diagnostic and often promotes meconium plugs to be expelled. The colon is normal and there are no sequelae.

Differentials are for failure to pass meconium and include meconium ileus (should have right-sided filling defects and microcolon).

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Case information

rID: 62796
Published: 29th Aug 2018
Last edited: 26th Jan 2019
System: Paediatrics
Inclusion in quiz mode: Included
Institution: NHS Lothian

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