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
Tsitsiou Y et al: Diagnostic decision-making tool for imaging term neonatal bowel obstruction. Clin Radiol. 76(3):163-71, 2021
Galante G et al: Gastrointestinal, pancreatic, and hepatic manifestations of cystic fibrosis in the newborn. Neoreviews. 20(1):e12-4, 2019
Schauble AL et al: N-acetylcysteine for management of distal intestinal obstruction syndrome. J Pediatr Pharmacol Ther. 24(5):390-7, 2019
Gunderman PFR et al: Fetal MRI in management of complicated meconium ileus: prenatal and surgical imaging. Prenat Diagn. 38(9):685-91, 2018
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
Sathe M et al: Meconium ileus in cystic fibrosis. J Cyst Fibros. 16 Suppl 2:S32-9, 2017
Kelly T et al: Gastrointestinal manifestations of cystic fibrosis. Dig Dis Sci. 60(7):1903-13, 2015
Maxfield CM et al: A pattern-based approach to bowel obstruction in the newborn. Pediatr Radiol. 43(3):318-29, 2013
Karimi A et al: Issues in the management of simple and complex meconium ileus. Pediatr Surg Int. 27(9):963-8, 2011
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
Colombani M et al: Fetal gastrointestinal MRI: all that glitters in T1 is not necessarily colon. Pediatr Radiol. 40(7):1215-21, 2010
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
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
Johnson JA et al: Does presenting with meconium ileus affect the prognosis of children with cystic fibrosis? Pediatr Pulmonol. 45(10):951-8, 2010
Copeland DR et al: Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg. 44(11):2130-2, 2009
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
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
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
Eckoldt F et al: Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn. 23(11):904-8, 2003
Burke MS et al: New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 37(5):760-4, 2002
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
Berrocal T et al: Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19(5):1219-36, 1999
De Backer AI et al: Radiographic manifestations of intestinal obstruction in the newborn. JBR-BTR. 82(4):159-66, 1999
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
Mushtaq I et al: Meconium ileus secondary to cystic fibrosis. the East London experience. Pediatr Surg Int. 13(5-6):365-9, 1998
Murshed R et al: Meconium ileus: a ten-year review of thirty-six patients. Eur J Pediatr Surg. 7(5):275-7, 1997
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
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
Stringer MD et al: Meconium ileus due to extensive intestinal aganglionosis. J Pediatr Surg. 29(4):501-3, 1994
Docherty JG et al: Meconium ileus: a review 1972-1990. Br J Surg. 79(6):571-3, 1992
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
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
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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
Tsitsiou Y et al: Diagnostic decision-making tool for imaging term neonatal bowel obstruction. Clin Radiol. 76(3):163-71, 2021
Galante G et al: Gastrointestinal, pancreatic, and hepatic manifestations of cystic fibrosis in the newborn. Neoreviews. 20(1):e12-4, 2019
Schauble AL et al: N-acetylcysteine for management of distal intestinal obstruction syndrome. J Pediatr Pharmacol Ther. 24(5):390-7, 2019
Gunderman PFR et al: Fetal MRI in management of complicated meconium ileus: prenatal and surgical imaging. Prenat Diagn. 38(9):685-91, 2018
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
Sathe M et al: Meconium ileus in cystic fibrosis. J Cyst Fibros. 16 Suppl 2:S32-9, 2017
Kelly T et al: Gastrointestinal manifestations of cystic fibrosis. Dig Dis Sci. 60(7):1903-13, 2015
Maxfield CM et al: A pattern-based approach to bowel obstruction in the newborn. Pediatr Radiol. 43(3):318-29, 2013
Karimi A et al: Issues in the management of simple and complex meconium ileus. Pediatr Surg Int. 27(9):963-8, 2011
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
Colombani M et al: Fetal gastrointestinal MRI: all that glitters in T1 is not necessarily colon. Pediatr Radiol. 40(7):1215-21, 2010
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
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
Johnson JA et al: Does presenting with meconium ileus affect the prognosis of children with cystic fibrosis? Pediatr Pulmonol. 45(10):951-8, 2010
Copeland DR et al: Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg. 44(11):2130-2, 2009
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
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
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
Eckoldt F et al: Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn. 23(11):904-8, 2003
Burke MS et al: New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 37(5):760-4, 2002
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
Berrocal T et al: Congenital anomalies of the small intestine, colon, and rectum. Radiographics. 19(5):1219-36, 1999
De Backer AI et al: Radiographic manifestations of intestinal obstruction in the newborn. JBR-BTR. 82(4):159-66, 1999
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
Mushtaq I et al: Meconium ileus secondary to cystic fibrosis. the East London experience. Pediatr Surg Int. 13(5-6):365-9, 1998
Murshed R et al: Meconium ileus: a ten-year review of thirty-six patients. Eur J Pediatr Surg. 7(5):275-7, 1997
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
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
Stringer MD et al: Meconium ileus due to extensive intestinal aganglionosis. J Pediatr Surg. 29(4):501-3, 1994
Docherty JG et al: Meconium ileus: a review 1972-1990. Br J Surg. 79(6):571-3, 1992
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
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
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