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Meconium Plug Syndrome

(Small Left Colon Syndrome)

By Eric Gibson, MD, Nemours/Alfred I. duPont Nemours Hospital for Children, Thomas Jefferson University ; Ursula Nawab, MD, Thomas Jefferson University/Nemours

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Meconium plug syndrome is colonic obstruction caused by thick meconium.

Meconium plug syndrome usually occurs in infants who are otherwise healthy, but it is more common among premature infants, infants of diabetic mothers, and toxemic mothers treated with Mg sulfate. It is generally regarded as a functional immaturity of the colon, resulting in failure to pass the first stool.

Symptoms and Signs

Infants present in the first few days of life with failure to pass stools, abdominal distention, and vomiting. Thick, inspissated, rubbery meconium forms a cast of the colon, resulting in complete obstruction.

Diagnosis

  • Radiographic contrast enema

  • Sometimes testing for Hirschsprung disease

Diagnosis is of exclusion and should be differentiated primarily from Hirschsprung disease (see Hirschsprung Disease ).

Plain abdominal x-rays are nonspecific and can show signs of low intestinal obstruction. Conversely, contrast enema shows the characteristic appearance of the outline of the inspissated meconium against the wall of the colon, providing a double-contrast impression. Unlike meconium ileus, microcolon is not typically seen on x-ray with meconium plug syndrome.

Treatment

  • Radiographic contrast enema

The water-soluble contrast enema can be therapeutic by separating the plug from the intestinal wall and expelling it. Occasionally, repeated enemas are required. Rarely, surgical decompression is required. Although most infants are healthy thereafter, diagnostic studies may be needed to rule out Hirschsprung disease or cystic fibrosis.

* This is the Professional Version. *