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Case of the Month

by Dr Noreen Norfaraheen Lee Abdullah MD (UKM), MMed Radiology (UKM), AM(Mal)

Answer to Case Of the Month 
Meconium Plug Syndrome

Discussion of Findings
Contrast enema showed a moderately dilated colon filled with radiolucent material: the meconium plug.

Meconium Plug Syndrome

This is a form of neonatal intestinal obstruction. It occurs as a result of colonic inertia with failure of passage of meconium from the colon. There is transient distal colon or rectal obstruction caused by inspissated meconium. Typical presentation will be a term newborn with symptoms of intestinal obstruction on the second to third day of life. Many patients have no apparent risk factors.

Meconium plug syndrome is also observed in premature infants of diabetic mothers and in infants whose mothers received magnesium sulfate for treatment of toxemia. Newborns with cystic fibrosis may present with meconium plug syndrome, although meconium ileus is more frequent and characteristic in these patients.
The signs include vomiting (bilious or non bilious), abdominal distension and failure to pass meconium in the first 24 hours of life. Radiographs show low intestinal obstruction with numerous dilated bowel loops. An enema is indicated at this instance.

Barium can be used and the diagnosis is made when the meconium plug is outlined. Barium enema can also be therapeutic and with rectal stimulation will successfully induce the passage of the meconium.

Water-soluble contrast is preferred, as it aids in expelling the meconium plugs. Gastrografin is employed, which is a hypertonic solution containing both wetting and detergent agents which aids tremendously in expelling the plug. However, complications secondary to hyperosmolarity can occur that might produce dehydration. Therefore it is important the baby is well hydrated before the procedure.

Generally, infants with meconium plug syndrome have normal bowel function after passing the meconium plug. The response to the enema is often dramatic, with immediate passage of meconium and resolution of intestinal dilatation. In some patients, clinical findings persist and a second enema may be performed for therapy.

About the Author 
Dr Noreen, a Consultant Radiologist is currently with the Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
 
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Last Updated:
Tuesday, 04 January 2005