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Pediatrics
Diagnosis
Gastrointestinal
Neonatal Lower Intestinal Obstructions
Meconium Ileus
Meconium Ileus
Steven J. Kraus, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Meconium ileus (MI): Neonatal obstruction of distal ileum due to abnormally thick, tenacious meconium
                • Up to 90% of MI patients have cystic fibrosis (CF)
                • Presenting illness in 10-20% of CF newborns
              • Complicated MI: Superimposed ischemia, volvulus, atresia, &/or perforation in up to 50% of MI cases

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Tsitsiou Y et al: Diagnostic decision-making tool for imaging term neonatal bowel obstruction. Clin Radiol. 76(3):163-71, 2021
                                        2. Galante G et al: Gastrointestinal, pancreatic, and hepatic manifestations of cystic fibrosis in the newborn. Neoreviews. 20(1):e12-4, 2019
                                        3. Schauble AL et al: N-acetylcysteine for management of distal intestinal obstruction syndrome. J Pediatr Pharmacol Ther. 24(5):390-7, 2019
                                        4. Gunderman PFR et al: Fetal MRI in management of complicated meconium ileus: prenatal and surgical imaging. Prenat Diagn. 38(9):685-91, 2018
                                        5. Rubio EI et al: Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes. Pediatr Radiol. 47(4):411-21, 2017
                                        6. Sathe M et al: Meconium ileus in cystic fibrosis. J Cyst Fibros. 16 Suppl 2:S32-9, 2017
                                        7. Kelly T et al: Gastrointestinal manifestations of cystic fibrosis. Dig Dis Sci. 60(7):1903-13, 2015
                                        8. Maxfield CM et al: A pattern-based approach to bowel obstruction in the newborn. Pediatr Radiol. 43(3):318-29, 2013
                                        9. Karimi A et al: Issues in the management of simple and complex meconium ileus. Pediatr Surg Int. 27(9):963-8, 2011
                                        10. van der Doef HP et al: Intestinal obstruction syndromes in cystic fibrosis: meconium ileus, distal intestinal obstruction syndrome, and constipation. Curr Gastroenterol Rep. 13(3):265-70, 2011
                                        11. Colombani M et al: Fetal gastrointestinal MRI: all that glitters in T1 is not necessarily colon. Pediatr Radiol. 40(7):1215-21, 2010
                                        12. Efrati O et al: Meconium ileus in patients with cystic fibrosis is not a risk factor for clinical deterioration and survival: the Israeli Multicenter study. J Pediatr Gastroenterol Nutr. 50(2):173-8, 2010
                                        13. Gorter RR et al: Clinical and genetic characteristics of meconium ileus in newborns with and without cystic fibrosis. J Pediatr Gastroenterol Nutr. 50(5):569-72, 2010
                                        14. Johnson JA et al: Does presenting with meconium ileus affect the prognosis of children with cystic fibrosis? Pediatr Pulmonol. 45(10):951-8, 2010
                                        15. Copeland DR et al: Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg. 44(11):2130-2, 2009
                                        16. Carcopino X et al: Use of fetal magnetic resonance imaging in differentiating ileal atresia from meconium ileus. Ultrasound Obstet Gynecol. 28(7):976-7, 2006
                                        17. Munck A et al: Clinical outcome of cystic fibrosis presenting with or without meconium ileus: a matched cohort study. J Pediatr Surg. 41(9):1556-60, 2006
                                        18. Lai HJ et al: Association between initial disease presentation, lung disease outcomes, and survival in patients with cystic fibrosis. Am J Epidemiol. 159(6):537-46, 2004
                                        19. Eckoldt F et al: Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn. 23(11):904-8, 2003
                                        20. Hajivassiliou CA: Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 12(4):241-53, 2003
                                        21. Burke MS et al: New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 37(5):760-4, 2002
                                        22. Oliveira MC et al: Effect of meconium ileus on the clinical prognosis of patients with cystic fibrosis. Braz J Med Biol Res. 35(1):31-8, 2002
                                        23. Berrocal T et al: Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19(5):1219-36, 1999
                                        24. De Backer AI et al: Radiographic manifestations of intestinal obstruction in the newborn. JBR-BTR. 82(4):159-66, 1999
                                        25. Feingold J et al: Genetic comparisons of patients with cystic fibrosis with or without meconium ileus. Clinical Centers of the French CF Registry. Ann Genet. 42(3):147-50, 1999
                                        26. Mushtaq I et al: Meconium ileus secondary to cystic fibrosis. the East London experience. Pediatr Surg Int. 13(5-6):365-9, 1998
                                        27. Buonomo C: Neonatal gastrointestinal emergencies. Radiol Clin North Am. 35(4):845-64, 1997
                                        28. Murshed R et al: Meconium ileus: a ten-year review of thirty-six patients. Eur J Pediatr Surg. 7(5):275-7, 1997
                                        29. Neal MR et al: Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia. J Ultrasound Med. 16(4):263-6; quiz 267-8, 1997
                                        30. Kao SC et al: Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology. Pediatr Radiol. 25(2):97-100, 1995
                                        31. Stringer MD et al: Meconium ileus due to extensive intestinal aganglionosis. J Pediatr Surg. 29(4):501-3, 1994
                                        32. Docherty JG et al: Meconium ileus: a review 1972-1990. Br J Surg. 79(6):571-3, 1992
                                        33. Leonidas JC et al: Meconium ileus and its complications. A reappraisal of plain film roentgen diagnostic criteria. Am J Roentgenol Radium Ther Nucl Med. 108(3):598-609, 1970
                                        34. Berdon WE et al: Microcolon in newborn infants with intestinal obstruction. Its correlation with the level and time of onset of obstruction. Radiology. 90(5):878-85, 1968
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Meconium ileus (MI): Neonatal obstruction of distal ileum due to abnormally thick, tenacious meconium
                                                      • Up to 90% of MI patients have cystic fibrosis (CF)
                                                      • Presenting illness in 10-20% of CF newborns
                                                    • Complicated MI: Superimposed ischemia, volvulus, atresia, &/or perforation in up to 50% of MI cases

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • Fluoroscopic Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Tsitsiou Y et al: Diagnostic decision-making tool for imaging term neonatal bowel obstruction. Clin Radiol. 76(3):163-71, 2021
                                                                              2. Galante G et al: Gastrointestinal, pancreatic, and hepatic manifestations of cystic fibrosis in the newborn. Neoreviews. 20(1):e12-4, 2019
                                                                              3. Schauble AL et al: N-acetylcysteine for management of distal intestinal obstruction syndrome. J Pediatr Pharmacol Ther. 24(5):390-7, 2019
                                                                              4. Gunderman PFR et al: Fetal MRI in management of complicated meconium ileus: prenatal and surgical imaging. Prenat Diagn. 38(9):685-91, 2018
                                                                              5. Rubio EI et al: Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes. Pediatr Radiol. 47(4):411-21, 2017
                                                                              6. Sathe M et al: Meconium ileus in cystic fibrosis. J Cyst Fibros. 16 Suppl 2:S32-9, 2017
                                                                              7. Kelly T et al: Gastrointestinal manifestations of cystic fibrosis. Dig Dis Sci. 60(7):1903-13, 2015
                                                                              8. Maxfield CM et al: A pattern-based approach to bowel obstruction in the newborn. Pediatr Radiol. 43(3):318-29, 2013
                                                                              9. Karimi A et al: Issues in the management of simple and complex meconium ileus. Pediatr Surg Int. 27(9):963-8, 2011
                                                                              10. van der Doef HP et al: Intestinal obstruction syndromes in cystic fibrosis: meconium ileus, distal intestinal obstruction syndrome, and constipation. Curr Gastroenterol Rep. 13(3):265-70, 2011
                                                                              11. Colombani M et al: Fetal gastrointestinal MRI: all that glitters in T1 is not necessarily colon. Pediatr Radiol. 40(7):1215-21, 2010
                                                                              12. Efrati O et al: Meconium ileus in patients with cystic fibrosis is not a risk factor for clinical deterioration and survival: the Israeli Multicenter study. J Pediatr Gastroenterol Nutr. 50(2):173-8, 2010
                                                                              13. Gorter RR et al: Clinical and genetic characteristics of meconium ileus in newborns with and without cystic fibrosis. J Pediatr Gastroenterol Nutr. 50(5):569-72, 2010
                                                                              14. Johnson JA et al: Does presenting with meconium ileus affect the prognosis of children with cystic fibrosis? Pediatr Pulmonol. 45(10):951-8, 2010
                                                                              15. Copeland DR et al: Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg. 44(11):2130-2, 2009
                                                                              16. Carcopino X et al: Use of fetal magnetic resonance imaging in differentiating ileal atresia from meconium ileus. Ultrasound Obstet Gynecol. 28(7):976-7, 2006
                                                                              17. Munck A et al: Clinical outcome of cystic fibrosis presenting with or without meconium ileus: a matched cohort study. J Pediatr Surg. 41(9):1556-60, 2006
                                                                              18. Lai HJ et al: Association between initial disease presentation, lung disease outcomes, and survival in patients with cystic fibrosis. Am J Epidemiol. 159(6):537-46, 2004
                                                                              19. Eckoldt F et al: Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn. 23(11):904-8, 2003
                                                                              20. Hajivassiliou CA: Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 12(4):241-53, 2003
                                                                              21. Burke MS et al: New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 37(5):760-4, 2002
                                                                              22. Oliveira MC et al: Effect of meconium ileus on the clinical prognosis of patients with cystic fibrosis. Braz J Med Biol Res. 35(1):31-8, 2002
                                                                              23. Berrocal T et al: Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19(5):1219-36, 1999
                                                                              24. De Backer AI et al: Radiographic manifestations of intestinal obstruction in the newborn. JBR-BTR. 82(4):159-66, 1999
                                                                              25. Feingold J et al: Genetic comparisons of patients with cystic fibrosis with or without meconium ileus. Clinical Centers of the French CF Registry. Ann Genet. 42(3):147-50, 1999
                                                                              26. Mushtaq I et al: Meconium ileus secondary to cystic fibrosis. the East London experience. Pediatr Surg Int. 13(5-6):365-9, 1998
                                                                              27. Buonomo C: Neonatal gastrointestinal emergencies. Radiol Clin North Am. 35(4):845-64, 1997
                                                                              28. Murshed R et al: Meconium ileus: a ten-year review of thirty-six patients. Eur J Pediatr Surg. 7(5):275-7, 1997
                                                                              29. Neal MR et al: Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia. J Ultrasound Med. 16(4):263-6; quiz 267-8, 1997
                                                                              30. Kao SC et al: Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology. Pediatr Radiol. 25(2):97-100, 1995
                                                                              31. Stringer MD et al: Meconium ileus due to extensive intestinal aganglionosis. J Pediatr Surg. 29(4):501-3, 1994
                                                                              32. Docherty JG et al: Meconium ileus: a review 1972-1990. Br J Surg. 79(6):571-3, 1992
                                                                              33. Leonidas JC et al: Meconium ileus and its complications. A reappraisal of plain film roentgen diagnostic criteria. Am J Roentgenol Radium Ther Nucl Med. 108(3):598-609, 1970
                                                                              34. Berdon WE et al: Microcolon in newborn infants with intestinal obstruction. Its correlation with the level and time of onset of obstruction. Radiology. 90(5):878-85, 1968