Colonic atresia is a rare cause for failure to pass meconium, and a rare site for an atresia in the GI tract (esophagus, ileum and duodenum are all more common). 

The diagnosis was suspected following the barium enema, but not certain without the surgical findings. The enema appearances could potentially have represented a stricture or large plug. 

At theater the patient had a short segment atresia involving the distal descending and sigmoid colon. The segment was resected with an end to end anastomosis and de-functioning ileostomy. The ileostomy was successfully reversed 6 weeks later, and the patient recovered well.