komplizierter Mekoniumileus

Newborn with

a distended abdomen. AXR shows displacement of much of the bowel to the left lower quadrant of the abdomen. Faint cresenteric calcifications are seen arcing upwards and downwards on the right side of the abdomen while an oval-shaped calcified object is seen on the left side of the abdomen at the level of the L1 and L2 vertebral bodies. Nodular appearing calcifications are scattered throughout the abdomen.The diagnosis was complicated meconium ileus. A large meconium pseudocyst was encountered in the operating room.

pediatricimaging.org • CC-by-nc-sa 4.0

Infant with

cecal perforation just after birth status post diverting colostomy who now presents for reanastomosis a year later. AP image from an enema shows an unused microcolon.The diagnosis was complicated meconium ileus causing cecal perforation postnataly.

pediatricimaging.org • CC-by-nc-sa 4.0

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komplizierter Mekoniumileus

Mekoniumileus Radiopaedia • CC-by-nc-sa 3.0 • de

Meconium ileus refers to a neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium. Unlike in the meconium plug syndrome, the meconium is abnormal in consistency.

Epidemiology

Meconium ileus is more common in white populations and affects both sexes almost equally.

Pathology

Meconium found in the intestine of a neonate consists of succus entericus (bile salts, bile acids, and debris from the intestinal mucosa) and is normally evacuated within 6 hours of birth (or earlier).

Meconium ileus occurs when meconium becomes inspissated and obstructs the distal ileum. It is usually a manifestation of cystic fibrosis. Approximately 20% of infants with cystic fibrosis present with meconium ileus at birth.

Although it is usually understood as synonymous with cystic fibrosis until proven otherwise, it may also be seen with pancreatic atresia or stenosis of the pancreatic duct.

Only rarely does it occur without cystic fibrosis or pancreatic abnormality, and is thought to be related to gut immaturity (more favorable outcome).

Radiographic features

Plain radiograph

Non-specific and may show dilated bowel loops proximal to the impaction. Classically, there is a paucity or absence of air-fluid levels and a "bubbly" appearance of the distended intestinal loops on radiographs. Occasionally, has a mottled appearance on radiographs during the first 2 days of life.

Fluoroscopy

Contrast enema will show a microcolon involving the entire large bowel and may show impacted meconium pellets filling defects, particularly in the right colon or in the distal ileum.