It is the most common form of functional bowel obstruction in the newborn, with an incidence of 1500 newborns. The significance of meconium plug syndrome is dependent on the underlying diagnosis. Pdf meconium peritonitis mp is defined as an aseptic, localized or generalized. Current significance of meconium plug syndrome sciencedirect. Meconium abnormalities are characterized by a wide spectrum of severity, from. Plain film diagnosis in meconium plug syndrome, meconium ileus and neonatal hirschsprungs disease a scoring system s. Meconium ileus is similar to meconium plug syndrome except that it is the small intestine that is blocked by meconium and it is usually caused by the inherited disorder cystic fibrosis. Meconium plug is diagnosed by recognition of the passage of abnormal meconium after. From battlefields of moral perversion, narcotic craving and mental depravation now comes the first fulllength meconium release aparts of bodya flying in like the white pidgeon landing on the very horn of the horned almighty to take a dump on his goaty forehead.
Delay in the passage of the first stool in term neonates may be associated with lower intestinal obstruction, that is, meconium plug syndrome, hirschsprung disease, and imperforate anus. Sep 25, 2014 meconium plug syndrome was first reported by clatworthy in 1956, describing a syndrome of colonic obstruction because of inspissated meconium. Meconium, unlike later feces, is viscous and sticky like tar, its color usually being a very dark olive green. Meconium plug syndrome may be a sign of other disorders, such as hirschsprung disease. Sign up for the nature briefing newsletter what matters in science, free to your inbox daily. Meconium aspiration syndrome genetic and rare diseases. The meconiumplug syndrome and hirschsprungs disease. Neonatal intussusception associated with neonatal small left. Most aspiration of meconium probably occurs before birth.
Pulling the plugmanagement of meconium plug syndrome in. T he intelligent management of newborn infants who have symptoms or signs of intestinal obstruction requires a familiarity with the meconium plug syndrome. Meconium plug syndrome msd manual professional edition. After birth, 60% of healthy fullterm neonates stool for the first time by 8 hours of life, 91% by 16 hours, 98. Diagnosis is based on radiographic contrast enema and sometimes testing for hirschsprung disease. The association of diabetic mothers giving birth to babies with small descending colon syndrome was subsequently recognizedwith anincidence of 40% to 50% 5,6. Nondelivery room management of meconium aspiration. Hop 2 1 department of pediatric radiology, sophia childrens hospital, erasmus university, rotterdam, the netherlands. Plain film diagnosis in meconium plug syndrome, meconium ileus. The clinical picture is that of a low small bowel obstruction in the neonatal. Meconium ileus has a significant risk of intestinal perforation. Meconium ileus can be subdivided into simple and complex. Starshak rj, sty jr, bruce js meconium plug syndrome associated with.
Meconium ileus, meconium plug syndrome, and distal intestinal. Meconium aspiration syndrome mas also known as neonatal aspiration of meconium is a medical condition affecting newborn infants. Meconium is the earliest stool of a mammalian infant. Symptoms and signs infants present in the first few days of life with failure to pass stools, abdominal distention, and vomiting. Meconium aspiration syndrome clinical presentation. The incidence is one in 1,000 births, and it is associated with hirschsprung disease in 40% of cases and cystic. Small descending colon syndrome has been associated with meconium plug syndrome since the initial report 1. Meconium plug syndrome is the most common form of functional bowel obstruction in the newborn, with an incidence of 1500. Meconium plug syndrome, also termed functional immaturity of the colon, is a transient disorder of the newborn colon characterized by delayed. Feb 15, 2017 meconium plug syndrome is a diagnosis of exclusion.
Calcified meconium flecks enclosing the peritoneal surfaces and the scrotum are encountered in meconium peritonitis. Meconium plug syndrome is a transient functional abnormality of the newborns digestive system which consists of the delayed passage of the meconium beyond 2448 hours, abdominal distension, vomiting, and dilatation of the left colon. The meconiumplug syndrome is unrelated to cystic fibrosis and meconium ileus. Evidence based medicine cochrane collaboration on meconium plug syndrome. Contrast enema usually excludes congenital small bowel obstruction and rare colon abnormalities such as atresia or duplication. The condition may occur as a result of other disorders such as cystic fibrosis, colon atresia, narrowed colon, impaired intestinal motility hirschsprung disease or for no apparent reason. In this situation, it is also termed the small left colon syndrome. Treatments for meconium plug syndrome including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. Intestinal secretions, mucosal cells, and solid elements of swallowed amniotic fluid are the 3 major solid constituents of meconium.
Acause of neonatal intestinal obstruction byleonard e. Pediatric meconium ileus signs and symptoms medical. Meconium plug syndrome definition of meconium plug syndrome. Thick, inspissated, rubbery meconium forms a cast of the colon, resulting in complete obstruction. Meconium plug syndrome, as opposed to meconium ileus, is not necessarily associated with cf. It is a transient form of distal colonic or rectal obstruction caused by hard, immobile meconium. Pdf primary segmental volvulus of the ileum mimicking. Article information, pdf download for neonatal intussusception associated with. Meconium found in the intestine of a neonate consists of.
Late soap bubble pattern after 1218 hours of life secondary to peristaltic migration of air in the colon is suggestive of meconium plug syndrome. This contrasts to the intraluminal obstruction of the terminal ileum in meconium ileus. Mas can present with varying degrees of severity from mild respiratory distress to lifethreatening respiratory failure. This can cause breathing difficulties due to swelling inflammation in the babys lungs after birth. A free powerpoint ppt presentation displayed as a flash slide show on id. In meconium plug syndrome, the colon is completely blocked with thick meconium. If the baby stools normally after initial evacuation, additional workup is usually not necessary. Meconium forms a cast of the colon, and the colon remains normal in caliber. These patients present within the first 24 hours of life with abdominal distension, vomiting, and. A plea is made to restrict the name meconium plug syndrome to cases in which the meconium plug is white and chalky and the consequent intestinal obstruction can be relieved by enemas, without evidence of intestinal dysfunction in later life.
The case described by townes and kopelman is of interest in that it suggests that isolated exocrine pancreatic deficiency may be a cause of the meconium plug syndrome mps. Meconium plug syndrome must be differentiated from other diseases that cause a failure to pass meconium or abdominal distension in infants, including small left colon syndrome. May, 2014 meconium plug syndrome, meconium ileus, and meconium ileus equivalent are conditions of gastrointestinal tract obstruction by thickened contents which will not pass. The following roentgen findings were almost always present in the meconium plug syndrome. Meconium obstruction in absence of cystic fibrosis in low. Mar 23, 2020 necrotizing enterocolitis nec is a grave differential of meconium ileus leading to intestinal obstruction. Unlike in the meconium plug syndrome, the meconium is abnormal in consistency. All 5 departments of 1, 3 pediatrics, 2 radiology, 4 surgery and, 5 pathology king faisal specialist hospital and research centre, riyadh, saudi arabia abstract. Clinical features and diagnosis of meconium aspiration. Meconium in amniotic fluid in childbirth icd10cm diagnosis code o77. Symptoms include failure to pass meconium within the first 24 to 48 hours after birth, abdominal distension, and vomiting if complete intestinal blockage occurs. Meconium plug syndrome pediatrics msd manual professional.
Ithas, however, been observed for some time and was infact alluded toasapossible cause ofobstruction inthe newborn infant. It is usually selflimited, however, and clears with a contrast enema undertaken to establish the diagnosis. Meconium plug syndrome merck manuals consumer version. Infants with meconium plug present with delayed passage of meconium, abdominal distention, and perhaps vomiting cuenca et al. The main differential consideration is hirschsprung disease, which is diagnosed eventually in approximately 1030% of patients with apparent meconium plug syndrome. Meconium ileus refers to a neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium. This article is from italian journal of pediatrics, volume 37. Soapbubble appearance by itself is not peculiar for meconium ileus and is also seen in patients with colonic atresia, hirschsprung disease, and meconium plug syndrome. Meconium plugs find pediatric treatment, find doctors.
Neonatal intestinal obstruction pediatrics clerkship the. The disease is diagnosed and treated by radiographic contrast enema, but hirschsprung disease and cystic fibrosis should be excluded. Meconium aspiration syndrome mas is a consequence of aspiration of meconium occurring before, during, or immediately after delivery and is one of the most common causes of respiratory failure in infants born at term or after term. Meconium plug syndrome is also associated with cystic fibrosis. The term meconium disease refers to meconium ileus and meconium plug syndrome. Meconium plug syndrome, cystic fibrosis, and exocrine. Meconium, a dark green material, is a newborns first stool. In meconium plug syndrome, there is meconium obstruction of the colon, often seen in infants of diabetic mothers or mothers who received magnesium sulfate for eclampsia. The authors experience with 14 cases of the meconium plug syndrome and cases of hirschsprungs disease is presented and the roentgenographic findings. Meconium plug syndrome is the intraluminal obstruction of the colon by abnormal meconium. It appears that the incidence of hirschsprungs disease remains around % as initially reported when the syndrome was defined. Infants with mas may be extremely ill and need extensive support.
A condition that can occur in newborns where a mass of thickened meconium obstructs the large intestines. Meconium plug syndrome symptoms, diagnosis, treatments and. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Meconium plug syndrome is also called functional immaturity of the colon. Meconium is the first intestinal discharge of the newborn epithelial cells, fetal hair, mucus, bile intrauterine stress. Neonatal intestinal obstruction pediatrics clerkship. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus. Meconium plug syndrome and meconium ileus springerlink. Risk factors of meconiumrelated ileus in very low birth. Meconium plugs found on contrast enema are associated with a % incidence of hirschsprungs disease in our experience. Newborns with simple meconium ileus present with intestinal obstruction characterized by abdominal distention, bilious emesis, and failure to pass meconium. One study noted that 16% of cases of meconium plug syndrome were associated with magnesium tocolysis and only 3% were associated with hirschsprung disease. We present a unique case of meconium plug syndrome associated with both cystic fibrosis and hirschsprungs disease. The infant may have visible peristalsis through the abdominal wall and palpable doughy bowel loops on abdominal exam.
Three cases of meconium plug syndrome recently seen at our hospital are reported. In a barium enema, meconium plug syndrome shows a normal or dilated colon as compared to microcolon in meconium ileus. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulmonary hypertension, and surfactant inactivation all play a role in the pathogenesis of meconium aspiration syndrome mas. Meconium plug syndrome msd manual consumer version. Meconium plug syndrome is colonic obstruction caused by thick meconium. Failure of a fullterm newborn to pass meconium in the first 24 hours may signal intestinal obstruction. The meconium blockage syndrome, also known as the meconium plug syndrome 1 or temporary meconium ileus 2, was described over a decade ago. Articles on meconium plug syndrome in n eng j med, lancet, bmj.
Meconium definition is a dark greenish mass that accumulates in the bowel during fetal life and is discharged shortly after birth. Meconium plug syndrome also termed functional immaturity of the colon, colonic immaturity, small left colon syndrome, and functional colonic obstruction is a transient disorder of the newborn colon characterized by delayed passage 2448 hr of meconium and intestinal dilatation. From pathomechanisms to treatment pregnancy and infants. Paula brills excellent pediatric radiology collection. Meconium plug syndrome associated with cystic fibrosis and. Meconium ileus, meconium plug syndrome, and distal. Meconium plug syndrome is the mildest and most common form of functional obstruction of the intestine in the newborn. Meconium plug syndrome neonatology diseases and disorders. The modern definition of the term was made by clatworthy and his coworkers in 1956 when they noted that newborn infants with intestinal obstruction due to the inability of the colon to rid itself of the meconium residue of nine months of fetal life. Meconium aspiration syndrome mas is a common respiratory disorder in term and nearterm neonates. Brill is a professor in the department of radiology pediatric section at weill cornell. Jan 12, 2012 meconium aspiration syndrome is a serious condition in which a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery.
The first intestinal discharge from newborns is meconium, which is a viscous, darkgreen substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions eg, bile. It is a transient form of distal colon or rectal obstruction caused by inspissated and dehydrated meconium, the etiology for which is unknown. Meconium plug syndrome free download as powerpoint presentation. If the meconium is abnormally thick or tarlike, it can block the large intestine colon. The meconium plug syndrome roentgen evaluation and differentiation from hirschsprungs disease and other pathologic states trn he meconium plug syndrome isa relatively frequent cause of colonic mechanical obstruction in the newborn272527 and isrelated tothefailure to pass meconium inthe first days oflife. However, there are little recent data in the literature.
The meconium plug syndrome is unrelated to cystic fibrosis and meconium ileus. The meconium plug syndrome revisited sciencedirect. Meconium plug syndrome refers to a functional colonic obstruction in a newborn due to an obstructing meconium plug. References 1 clatworthy jr hw, howard whr, lloyd j. On the basis of this observation, the authors suggest that the mps seen in our patients with cystic fibrosis cf was likewise probably due to pancreatic deficiency. Meconium plug syndrome radiology reference article. Labor and delivery complication by meconium in amniotic fluid. The incidence of pathologic finding, particularly hirschsprungs disease, contributing to the presence of these plugs, has been debated.
The incidence is one in 1,000 births, and it is associated with hirschsprung disease in 40% of cases and. Meconium aspiration syndrome mas is defined as respiratory distress in newborn infants born through meconium stained amniotic fluid msaf whose symptoms cannot be otherwise explained. Meconium aspiration syndrome mas, a common cause of respiratory failure in neonates, is associated with high mortality and morbidity. Timely passage of the first stool is a hallmark of the wellbeing of the newborn infant. Meconium plug syndrome merck manuals professional edition. Plain film diagnosis in meconium plug syndrome, meconium. Aspiration of meconium produces a syndrome characterized by hypoxia, hypercapnia, and acidosis. It describes the spectrum of disorders and pathophysiology of newborns born in meconium stained amniotic fluid msaf and have meconium within their lungs. The condition of ileal meconium plug is not as benign as a meconium plug in the rectum or distal colon. Meconium can be tested for various drugs, to check for in utero exposure. Current significance of meconium plug syndrome ncbi. Meconium plug syndrome, meconium ileus, and meconium ileus equivalent are conditions of gastrointestinal tract obstruction by thickened contents which will not pass. Meconium aspiration american academy of pediatrics.
The incidence of meconium plug syndrome is estimated to range from one case in 500 to one case in 1,000 neonates. The clinical picture is frequently indistinguishable, without contrast study of the colon, from other forms of mechanical intestinal obstruction requiring laparotomy. Pediatric meconium ileus signs and symptoms medical library. Meconium ileus is more common in white populations and affects both sexes almost equally.
These conditions are considered separately from functional or anatomic causes of neonatal intestinal obstruction, such as hirschsprung disease, intestinal atresia, and anorectal malformations. Ppt meconium aspiration syndrome powerpoint presentation. Meconium aspiration syndrome an overview sciencedirect. A term male infant with a birth weight of 3,300 gm was born by normal spontaneous vaginal delivery after an uncomplicated pregnancy to a 28yearold white woman. The meconium plug syndrome mps as defined by clatworthy et al is a transient form of distal colonic or rectal obstruction in newborn infants caused by inspissated, immobile meconium. It is usually transient and affects the left colon with meconium plugging the bowel distal to this segment. Meconium plug definition of meconium plug by medical dictionary. The association of mps and cf was noted to have been previously reported in only one patient.
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