Meconium Ileus

Meconium ileus is characterized by newborn bowel obstruction secondary to inspissated meconium impacted within the distal small bowel. Over 75% of cases are associated with cystic fibrosis. Affected infants typically present in the first 24–28 h of life with abdominal distension, feeding intolerance, and emesis. Complicated meconium ileus occurs when the meconium impaction is associated with atresia, volvulus, meconium peritonitis, or a meconium pseudocyst. Infants with complicated meconium ileus may present with signs of fetal distress or peritonitis at or shortly after birth. Diagnosis is made based on physical examination, abdominal radiographs, and contrast enema. Uncomplicated meconium ileus is initially treated non-surgically with solubilizing enemas to break up the meconium impaction and relieve the obstruction. If unsuccessful, surgical intervention is indicated. Complicated meconium ileus is surgical at diagnosis. Long-term complications of meconium ileus are associated with the underlying diagnosis of cystic fibrosis and include failure to thrive, pancreatic insufficiency, constipation, rectal prolapse, and distal intestinal obstruction syndrome.