Findings: Image #1 is a plain film of the abdomen which demonstrates findings suggestive of a low intestinal obstruction with multiple air-filled, distended loops of bowel. Image #2 is a single view from a Gastrografin enema which demonstrates a relatively small caliber left colon with an intraluminal filling defect extending proximally to the hepatic flexure. There is contrast within the stomach from a previous upper GI.
Diagnosis: Meconium plug syndrome.
Discussion: Meconium plug syndrome is a common cause of neonatal obstruction. It is felt to most likely be synonymous with "small left colon" syndrome and functional immaturity of the colon. These neonates generally present within the first 24 to 36 hours of age with abdominal distention, vomiting (bilious), and failure to pass meconium. Infants of diabetic mothers, as well as premature infants, are particularly predisposed to the entity. Plain films characteristically demonstrate findings consistent with a low intestinal obstruction. A contrast enema most commonly demonstrates distention of the right and transverse colon and a transition near the splenic flexure to a narrow descending colon and rectosigmoid region. In addition, meconium will be demonstrated within the colon. The major differential diagnostic consideration is Hirschsprung's disease. The roentgenographic findings may be similar, but in Hirschsprung's disease the aganglionic colon is usually of normal caliber, while it is usually small with meconium plug syndrome. In addition, the transition zone of meconium plug syndrome is usually abrupt whereas the transition zone in Hirschsprung's disease is more gradual.
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