Etiological considerations from histology and radiology article in pediatrics international 536. It is often the earliest clinical manifestation of cystic. Meconium plug syndrome radiology reference article. Meconium is the earliest stool of a mammalian infant. Meconium, unlike later feces, is viscous and sticky like tar, its color usually being a very dark olive green. In the past, mi was considered to be closely associated with cystic fibrosis cf. Incidence of meconium abnormalities in newborn infants. Meconium ileus is a small bowel obstruction in newborns caused by inspissated meconium. Meconium ileus is more common in white populations and affects both sexes almost equally. Meconium aspiration syndrome mas is an important cause of morbidity and mortality among term newborns.
Meconium ileus meconium ileus is obstruction of the terminal ileum by abnormally tenacious meconium. The incidence is one in 1,000 births, and it is associated with hirschsprung disease in 40% of cases and. Obstruction of the intestine ileus due to overly thick meconium. Conventional radiographic features of meconium peritonitis with secondary meconium pseudocyst formation are well described. Meconium ileus is the earliest clinical manifestation of cystic fibrosis cf and occurs in 810% of patients with cf at birth cf. Meconium consists of contents of the small bowel of neonates. Conversely, meconium ileus is the initial presentation of 10 to 15% of cf cases. Pediatric radiology abdominal neonatal meconium plug syndrome meconium plug syndrome in meconium plug syndrome, there is meconium obstruction of the colon, often seen in infants of diabetic mothers or mothers who received magnesium sulfate for eclampsia. Meconium plug syndrome is colonic obstruction caused by thick meconium. Learning about meconium staining alberta health services. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus. Meconium ileus accounts for about 33% of total neonatal bowel. In the past, meconium ileus mi was considered to be closely related to cystic fibrosis cf.
Conversely, contrast enema shows the characteristic appearance of the outline of the inspissated meconium against the wall of the colon, providing a doublecontrast impression. Review of the newborn nursery notes of 87 infants who had cystic fibrosis without meconium ileus mi indicated that 12 of them had clinical features consistent with the meconium plug syndrome mps. Meconium ileus mi is a unique form of congenital intestinal obstruction in which the meconium of the fetus forms concretions in the distal ileum that completely occlude the bowel lumen mi is the first clinical manifestation of cf only 6% to 20% show the obstructive syndrome mi is considered pathognomonic for cf although mi may occur with pancreatic aplasia. It is usually transient and affects the left colon with meconium plugging the bowel distal to this segment. Any part of the gut can be affected, with problems including oesophageal atresia and tracheooesophageal fistula, anterior abdominal wall defects, congenital pyloric stenosis, atresia and stenosis of the small intestine, duplication of. Changing patterns of treatment and survival in neonates.
Kao sc, franken ea jr 1995 nonoperative treatment of simple meconium ileus. Complicated cases were managed by resection and anastomosis or enterostomy 14. Congenital abnormalities of the gastrointestinal tract usually manifest shortly after birth, but on occasion symptoms may be delayed for months or even years. Meconium ileus mi is a condition where the content of the babys bowel meconium is extremely sticky and causes the bowel to be blocked at birth. Meconium ileus is most often an early manifestation of cystic fibrosis, which causes gastrointestinal secretions to be extremely viscid and adherent to the intestinal mucosa. Meconium is normally evacuated within first 6 hours. Meconium ileus is responsible for about onethird of neonatal smallintestinal obstructions. Diagnosis is based on radiographic contrast enema and sometimes testing for hirschsprung disease. The meconium sometimes becomes thickened and congested in the intestines, a condition known as meconium ileus.
Meconium ileus represents obstruction of the distal ileum by viscous, impacted meconium pellets. Frothy or soapbubble pattern of bowel gas air mixed with meconium, often in the right lower quadrant dilated small bowel loops small bowel obstruction calcification due to meconium peritonitis 15% distal ileum packed with meconium and larger than microcolon on contrast enema. Meconium ileus equivalent is a condition which occurs in patients with cystic fibrosis where the ileum becomes obstructed by bowel content of abnormal consistency. Meconium ileus location question student doctor network. When your baby is born, meconium is the first stool your baby passes. May develop in utero and manifests within 48 hours of. Meconium ileus mi is one of the most common causes of intestinal obstruction in the newborn, accounting for 933% of neonatal intestinal obstructions. Meconium ileus mi is defined as an obstruction caused by inspissated meconium at the level of the terminal ileum 1, 2. Meconium ileus is a type of neonatal intestinal obstruction that occurs. Meconium ileus case presentation linkedin slideshare.
In this situation, it is also termed the small left colon syndrome. It describes the spectrum of disorders and pathophysiology of newborns born in meconium stained amniotic fluid msaf and have meconium within their lungs. Approximately 10% of infants with cystic fibrosis develop meconium ileus. Radiology page interesting cases medical company 375. Unlike in the meconium plug syndrome, the meconium is abnormal in consistency. It describes the spectrum of disorders and pathophysiology of newborns born in meconiumstained amniotic fluid msaf and have meconium within their lungs. Meconium plug syndrome also termed functional immaturity of the colon, colonic immaturity, small left colon syndrome, and functional colonic obstruction is a transient disorder of the newborn colon characterized by delayed passage 2448 hr of meconium and intestinal dilatation. Meconium plug syndrome refers to a functional colonic obstruction in a newborn due to an obstructing meconium plug. Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 85% for those with complicated meconium ileus. A result of antepartum or postpartum aspiration of. Meconium ileus and itscomplications areappraisal ofplain film roentgen diagnostic criteria byjohnc. This may need to be repeated within a few hours to completely clear the bowel. Meconium ileus definition of meconium ileus by the free.
Almost all cases are associated with an underlying diagnosis of cystic fibrosis cf. Mar 23, 2020 meconium ileus mi involves an obstruction of terminal ileum by abnormally thick and sticky meconium. Intestinal obstruction is caused by inspissation of thick, ropy, tenacious meconium, which is firmly adherent to the mucosa 2. Of 60 patients with cystic fibrosis and intestinal obstruction at birth meconium ileus more that half had complications of volvulus, atresia and intestinal perforation with meconium peritonitis.
Mar 15, 20 meconium ileus meconium ileus is obstruction of the terminal ileum by abnormally tenacious meconium. May develop in utero and manifests within 48 hours of birth. Meconium ileus surgical management linkedin slideshare. Me conium ileus is a specific disorder occurring in the neonatal period, usually a manifestation of cystic fibrosis of the pancreas. Most infants with meconium ileus have a disease called cystic fibrosis. Gi perforation releases meconium into abdominal cavity, inducing sterile inflammatory reaction and calcium deposition perforation may be due to anoxia leading to bowel ischemia, atresia, congenital bands, hirschprung disease, internal hernia, meconium ileus, stenosis, volvulus or idiopathic. Most infants with meconium ileus have cystic fibrosis, a congenital. Meconium ileus article about meconium ileus by the free. Meconium plug syndrome merck manuals professional edition. The effects of meconium ileus vary from baby to baby.
Meconium ileus refers to a neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium. May 29, 2014 meconium ileus equivalent is a condition which occurs in patients with cystic fibrosis where the ileum becomes obstructed by bowel content of abnormal consistency. Ileus is a surgical emergency that may or may not require surgical intervention. Meconium ileus definition of meconium ileus by medical. Meconium ileus is most often an early manifestation of cystic fibrosis, which causes gi secretions to be extremely viscid and adherent to the intestinal mucosa. Meconium ileus is found almost exclusively in patients with cystic fibrosis, but only 20% of patients with cystic fibrosis have meconium ileus. More than 1870 distinct mutations of the cystic fibrosis transmembrane regulator cftr protein have been identified, some of which cause cf. Davis, in smiths anesthesia for infants and children eighth edition, 2011.
Obstruction of the small bowel in the terminal ileus from impacted meconium. In the womb, a baby swallows and digests the amniotic fluid. Of infants with meconium ileus, 80 to 90% have cystic fibrosis. In most cases the bowel itself is complete and intact but it is just the inside that is blocked. Meconium ileus occurs due to ileal obstruction in a new. Case of the week 320 on awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing over 200 powerpoint lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Meconium ileus occurs when meconium becomes inspissated and obstructs the distal ileus.
Ogilvie syndrome pseudoobstruction absent or reduced bowel sounds, usually associated with other comorbidities large bowel obstruction. Pediatric meconium ileus signs and symptoms medical library. Meconium ileus pediatrics msd manual professional edition. Generalized ileus air in dilated large and small bowel down to and including rectosigmoid. On call radiology gareth lewis hiten patel sachin modi shahid hussain download the ebook to your computer or access it anywhere with an internet browser. Case of the week 320 on awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi. Meconium ileus, in which intraluminal intestinal obstruction is secondary to inspissation of tenacious meconium in the terminal ileum, occurs in approximately 18% of newborns with cf.
Meconium aspiration syndrome mas, a common cause of respiratory failure in neonates, is associated with high mortality and morbidity. Meconiumrelated ileus in extremely lowbirthweight neonates. Contents xi key points 145 report checklist 145 meconium ileus 145 radiological. Plain abdominal radiographs are routinely the first imaging done for cases of meconium ileus. It is most often a neonatal manifestation of cystic fibrosis cf and occurs in ten to twenty percent of newborns with that disorder. In some babies it is possible to dissolve the sticky meconium by injecting a fluid via a soft tube into the babys bottom enema during the course of an xray.
Meconium ileus mi is congenital obstruction of the distal small bowel due to inspissated meconium within the ileum and sometimes the colon. Meconium ileus is a luminal obstruction of the distal small bowel by abnormal meconium. 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. Though the exact pathogenesis of mi in the absence of cf is not known, a.
Plain xray erect abdomen shows dilated gas filled stomach and duodenum with abrupt cut off black. Cardiac radiology genitourinary radiology learning radiology. Mar 03, 2016 meconium ileus is the earliest clinical manifestation of cystic fibrosis cf and occurs in 810% of patients with cf at birth cf. Meconium ileus is a bowel obstruction that occurs when the meconium in your childs intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum. A case of giant meconium pseudocyst secondary to ileum volvulus perforation is presented. Intercurrent chest infection or absence of pancreatic extract supplements are often the exacerbating cause.
But sometimes meconium comes out before the baby is born. Meconium ileus accounts for up to 33% of neonatal smallbowel obstructions. Meconium ileus results from a deficiency of trypsin and other. Therefore, mas has a wide range of severity depending on what conditions and complications develop. The radiology of meconium ileus equivalent the british. Of 60 patients with cystic fibrosis and intestinal obstruction at birth meconium ileus more that half had complications of volvulus, atresia and. Learning radiology calcification ligamentum arteriosum. This disease entity is often seen in neonates with cystic fibrosis. Meconium ileus is the presenting clinical manifestation of cystic fibrosis in 10 to 20% of cases. The study has been approved by the nres committee south centraloxford a ref. I newyork, new york b etween io and 20percentofpatients with cystic fibrosis present at birth with meconium ileus, aform ofsmall intestinal obstruction by. Meconium aspiration syndrome mas also known as neonatal aspiration of meconium is a medical condition affecting newborn infants. However, recent studies demonstrate that mi occurs frequently in the absence of cf as well 3, 4. Learningradiology meconium, ileus, cystic, fibrosis.
Our case is unusual in comparison to other cases reported in the literature and needs to be reported because the meconium pseudocyst presented without the. Meconium ileus is often the first sign of cystic fibrosis. The ascending, transverse and proximal descending colon black arrows are all dilated. Mutations in the cystic fibrosis transmembrane regulator encoding for chloride channel, results in reduced clearance of secretions. Meconium ileus is defined as bowel obstruction caused by inspissated meconium in the terminal ileum. This high incidence of meconium abnormalities suggests that mi and the mps probably represent different gradations of the same underlying. Issues in the management of simple and complex meconium ileus. A dark green fecal material that accumulates in the fetal intestines and is discharged at or near the time of birth.
Feb 15, 2017 meconium plug syndrome also termed functional immaturity of the colon, colonic immaturity, small left colon syndrome, and functional colonic obstruction is a transient disorder of the newborn colon characterized by delayed passage 2448 hr of meconium and intestinal dilatation. 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. The watersoluble contrast enema can be therapeutic by separating the plug from the intestinal wall and expelling it. Meconium ileus mi accounts for up to 33% of neonatal intestinal obstructions and occurs in approximately 20% of newborns diagnosed with cf. It may be secondary to either mechanical obstruction of the bowel mechanical ileus or a disturbance in neural stimulation adynamic ileus. Meconium is the first stool bowel movement that a newborn has.
Unlike meconium ileus, microcolon is not typically seen on xray with meconium plug syndrome. Mi is the only significant clinical manifestation of cf that is evident at birth. Any liveborn infant presenting between 01102012 and 30092014 with meconium ileus and cystic fibrosis. At top, a conventional radiograph of a newborn abdomen shows a mass in the right lower quadrant white arrow made up of loops of ileum with inspissated meconium, markedly dilated loops of bowel black arrow and a soapbubbly appearance to the meconium white oval.
There is a wellrecognised association of mi with cystic fibrosis cf. The meconium concentrations of sodium, potassium, and magnesium are almost twice as high in samples from normal children or well siblings than in samples from children with cystic fibrosis with or without meco nium ileus. The incidence is one in 1,000 births, and it is associated. It is associated with cystic fibrosis in nearly all cases, and up to 20% of newborns with cystic fibrosis present with meconium ileus. Pediatric meconium ileus signs and symptoms medical. Meconium ileusequivalent syndrome is a term applied to a partial small bowel obstruction in an older patient with known cystic fibrosis while the bowel gas pattern may resemble that of meconium ileus, the findings are not due to meconium which is present only in the newborn. Congenital abnormalities of the gastrointestinal tract. The remaining 9 patients with uncomplicated meconium ileus had resection and enterostomy. Meconium plug syndrome pediatrics msd manual professional. Dec 21, 2015 meconium ileus is a neonatal obstruction of the ileum by abnormally viscid, inspissated pellets of meconium.