Clinical Presentation of Meconium Ileus (MCQ)

Question

A female infant was born by vaginal delivery at 33 weeks and 5 days of gestational age with respiratory distress and severe abdominal distension and bilious vomiting.

The plain radiograph is shown to the right.

What is the likely diagnosis?

  • A. Meconium ileus.
  • B. Duodenal Atresia.
  • C. Hirschsprung's Disease.
  • D. Inguinal Hernia.
  • E. Intestinal Malrotation.

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Explanation

Clinical presentation of meconium ileus is with abdominal distension and bilious vomiting.

Viscous meconium in the terminal ileum may cause intestinal obstruction. It may be a manifestation of cystic fibrosis in approximately 10% of the CF population. Therefore, any baby with meconium ileus requires further investigation for CF.

There are often many gas-filled bowel loops, but without air-fluid levels. Air-fluid levels are thought not to occur because the meconium does not provide a good air-fluid interface. There may be a "soapy" mass in the right lower quadrant. A contrast enema will show a microcolon secondary to distal ileal obstruction. Calcification may be seen on a plain radiograph if there has been meconium peritonitis.

Gastrografin enemas may relieve the obstruction, but surgery may also be required.

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