meconium plug syndrome

Newborn with
failure to pass meconiumAXR shows a distal bowel obstruction. Water-soluble contrast enema shows normal caliber of the ascending and transverse colon and rectum, but decreased caliber of the descending (left) colon.The diagnosis was meconium plug syndrome.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
failure to pass meconium. Clinical image obtained after performance of a high osmolar water soluble enema and subsequent evacuation of contrast shows a one foot long continuous plug of meconium.The diagnosis was meconium plug syndrome.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
failure to pass meconium. AXR AP (above left) shows a dilated bowel gas pattern. AP image from an enema (above right) shows a normal caliber colon with the descending colon being slightly smaller in diameter than the rest of the colon. Large filling defects representing meconium are seen throughout the colon. The terminal ileum was refluxed. Clinical image (below) shows a foot-long piece of meconium that was evacuated by the patient after the exam.The diagnosis was meconium plug syndrome.
pediatricimaging.org • CC-by-nc-sa 4.0
nicht verwechseln mit: Mekoniumileus
Radiopaedia • CC-by-nc-sa 3.0 • de

Meconium plug syndrome refers to a functional colonic obstruction in a newborn due to an obstructing meconium plug. It is usually transient and affects the left colon with meconium plugging the bowel distal to this segment. In this situation, it is also termed the small left colon syndrome.

Pathology

Associations

Radiographic features

Radiograph

May show multiple dilated bowel loops which are a non-specific finding. There may be a caliber change around the splenic flexure.

Fluoroscopy: contrast enema

Contrast enema may demonstrate a small caliber to the left colon with multiple filling defects within due to retained meconium. The rectum is usually normal in size, unlike Hirschsprung disease. The use of high osmolar ionic contrast media for enema in a neonate or infant is controversial due to the risks associated with fluid shift .  The enema can be both diagnostic as well as therapeutic and is usually accompanied by the passage of meconium during or after the procedure.

Treatment and prognosis

Usually, resolves with time. Initial nonsurgical management includes rectal stimulation and contrast enema .

Differential diagnosis

On a plain radiograph consider most other causes of bowel obstruction. On a contrast enema consider:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Mekoniumpfropf-Syndrom:
Mekoniumileus
 
pediatricimaging.org • CC-by-nc-sa 4.0
mechanischer
Ileus
Wikipedia • CC BY-SA 4.0
Morbus
Hirschsprung
pediatricimaging.org • CC-by-nc-sa 4.0