Small left colon syndrome
Failure to pass meconium.
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The contrast-filled colon demonstrates a small caliber descending and sigmoid colon, along with loss of the haustral fold pattern. This also involves the splenic flexure. There are multiple filling defects within the left colon, keeping the retained meconium. The ascending and proximal 2/3 transverse colon has a normal caliber and haustral fold pattern. The rectosigmoid ratio is greater than 1. Contrast refluxed into normal appearing terminal ilium.
Nasogastric tube is present.
The 3 day old boy had not passed meconium. An enema fluoroscopic study was performed for diagnostic and therapeutic reasons. During the enema study the patient eventually passed large amount of meconium and demonstrated a small left colon.
The differential for this case includes
The rectosigmoid ratio was greater than 1, favoring meconium plug syndrome. Patient's final diagnosis was small left colon syndrome.