Is Meconium Obstruction Distinguishable from Intestinal Obstruction through Ultrasound?

Document Type : Original Article

Authors

1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Since the treatment of meconium ileus is very different from other types of intestinal obstruction, it is very important to distinguish these two entities. The aim of this study was to assess sonographic findings to differentiate meconium ileus from other types of obstruction.
Methods: This study was performed in Dr. Sheikh and Akbar hospitals, Mashhad Medical University of Science, Iran, during 2017- 2018. The imaging signs of 25 newborns (aged 2-8 days) with delayed passage of meconium were documented. These neonates were suspicious of low type intestinal obstruction. In cases with the simple form of meconium ileus and the small left colon syndrome, ultrasonic guided Gastrografin enema was performed for the treatment. In the patients with the failure of medical treatment and in other surgical cases, the appropriate surgical procedure was performed.
Results: The subjects in this study were diagnosed with small bowel atresia (n=9), a simple form of meconium ileus (n=6), a complicated form of meconium ileus (n=3), small left colon syndrome (n=3), bowel atresia and duplication (n=1), and Hirschsprung’s disease (n=3). The ultrasound findings were as follows: a totally or partially micro-colon in almost all patients, collapsed small bowel in right lower quadrant in all of the patients with bowel atresia, hypoechoic meconium in rectosigmoid in small left colon syndrome and Hirschsprung’s disease, hypoechoic tubular or beaded intraluminal inspissated meconium within terminal ileum, and the floating air bubbles (sonographic soap bubble sign) within fluids on proximal dilated loops in meconium ileus cases.
Conclusion: Although plain abdominal radiography confirmed bowel obstructions in all patients with delayed passage of meconium, it had a low level of specificity in the diagnosis and cause of obstruction.  Abdominal ultrasound had a high level of accuracy in the correct diagnosis of meconium obstructions and its differentiation from other intestinal obstructions. Accordingly, it eliminates the need to do a diagnostic contrast enema in order to differentiate these entities.

Keywords

References

1. Karimi A, Gorter RR, Sleeboom C, Kneepkens CM, Heij HA. Issues in the management of simple and complex meconium ileus. Pediatr Surg Int. 2011; 27(9):963-8.
2. Burke MS, Ragi JM, Karamanoukian HL, Kotter M, Brisseau GF, Borowitz DS, et al. New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 2002; 37(5):760-4.
3. Alamdaran SA, Mohamadipour A, Joodi M, Shojaeean R, Khademi G, Jafari SA, et al. Ultrasound- guided Hydrostatic (hydrocolonic) treatment of mec-onium ileus: a preliminary report. Int J Pediatr. 2018; 6(8):8111-8.
 4. Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol. 2016; 23(5):559-68.
 5. Rescorla FJ, Grosfeld JL, West KJ, Vane DW. Changing patterns of treatment and survival in neonates with meconium ileus. Arch Surg. 1989; 124(7):837-40.
6. Neal MR, Seibert JJ, Vanderzalm T, Wagner CW. Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia. J Ultrasound Med. 1997; 16(4):263-6.
 7. Barki Y, Bar-Ziv J. Meconium ileus: ultrasonic diagnosis of intraluminal inspissated meconium. J Clin Ultrasound. 1985; 13(7):509-12.
8. Loening-Baucke V, Kimura K. Failure to pass meconium: diagnosing neonatal intestinal obstruction date: Am Fam Physician. 1999; 60(7):2043-50.
9. Gupta AK, Guglani B. Imaging of congenital anomalies of the gastrointestinal tract. Indian J Pediatr. 2005; 72(5):403-14.
10. Hernanz-Schulman M. Imaging of neonatal gastrointestinal obstruction. Radiol Clin North Am. 1999; 37(6):1163-86.
11. Reid JR. Practical imaging approach to bowel obstruction in neonates: a review and update. Semin Roentgenol. 2012; 47(1):21-31.
12. Alamdaran SA, Hashemi J, Layegh P, Taghawi M. The diagnostic value of ultrasonography in pediatric intestinal malrotation. Growth. 2015; 5:3-8.
13. Taghavi M, Alamdaran SA, Feizi A. Diagnostic value of ultrasound and gastrointestinal series findings in detection of pediatric intestinal malrotation. Iran J Radiol. 2018, 15(2):e15089.
 14. Cheng G, Soboleski D, Daneman A, Poenaru D, Hurlbut D. Sonographic pitfalls in the diagnosis of enteric duplication cysts. Am J Roentgenol. 2005; 184(2):521-5.
Iranian Journal of Neonatology
Volume 10, Issue 1
March 2019
Pages 72-77

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