Small left colon syndrome

Case contributed by Dr Eric F Greif

Presentation

Failure to pass meconium.

Patient Data

Age: 3 days
Gender: Male
Fluoroscopy

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. No pre-sacral mass demonstrated in the lateral view. 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 with the tip in the stomach.

Case Discussion

The 3 days 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 a 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.

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Case information

rID: 30024
Published: 12th Jul 2014
Last edited: 9th Jun 2019
Tag: colon
Inclusion in quiz mode: Included

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