Meconium Ileus

 

Clinical findings:

(1) The neonate presents with bowel obstruction and a failure to pass meconium

(1a) abdominal distension

(1b) bilious vomiting

(2) A plain abdominal X-ray shows ground glass material without air-fluid levels

(3) The terminal ileum is filled with inspissated, sticky material.

(4) There is usually evidence of cystic fibrosis in the family and/or neonate. If there is no evidence of cystic fibrosis then chromosomal studies should be performed.

(5) Microcolon involving the entire colon secondary to disuse may be present initially.

 

Clinical Types	Features
simple	bowel obstruction
complicated	volvulus and/or bowel perforation with meconium peritonitis; intra-abdominal pseudocyst; bowel resection

 

Most patients with uncomplicated disease can be managed nonoperatively by dissolving the inspissated material. An attempt is made to deliver an enema containing a radiographic dye (meglumine diatrizoate or iohexol) plus N-acetylcysteine (Mucomyst) into the ileum. If this fails a surgical intervention to deliver N-acetylcysteine and to flush out the material may be attempted.

 

Therapy after the obstruction is relieved entails oral pancreatic enzyme replacement and nutritional support.