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Meconium ileus
Last reviewed: 12.07.2025
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Meconium ileus is an obstruction of the terminal ileum by abnormally viscous meconium; it almost always occurs in neonates with cystic fibrosis. Meconium ileus accounts for up to one-third of all cases of small bowel obstruction in neonates. Symptoms include vomiting that may contain bile, abdominal distension, and failure to pass meconium. Diagnosis is based on clinical presentation and radiographic findings. Treatment involves enemas with dilute contrast media for fluoroscopy and surgery if enemas fail to respond.
Meconium ileus is almost always an early manifestation of cystic fibrosis, in which all secretions in the gastrointestinal tract become very viscous and adhere to the intestinal mucosa. The obstruction occurs at the level of the terminal ileum (in contrast to the colonic obstruction in meconium impaction syndrome), usually develops in utero, and can be diagnosed prenatally by ultrasound. Distal to the site of obstruction, the intestine is narrowed and does not contain or contains a small amount of meconium. A small-caliber intestine that is virtually free of contents is called a microcolon.
In approximately half of cases, such sequelae as incomplete rotation, intestinal atresia, or perforation are observed. Stretched loops of the small intestine during the intrauterine period can twist, forming a valve. If the blood supply to the intestine is then disrupted and an infarction develops, this can lead to the development of sterile meconium peritonitis. The intestinal loop in which the infarction developed can be absorbed, after which areas of intestinal atresia are formed.
[ Symptoms of meconium ileus
Newborns with a family history of cystic fibrosis should have ultrasound monitoring every 6 weeks to detect meconium ileus. After birth, infants with meconium ileus usually have manifestations of intestinal obstruction - either a simple form with abdominal distension and absence of meconium, or more serious forms with the development of peritonitis and respiratory distress syndrome. Loops of distended small intestine, which can sometimes be palpated through the anterior abdominal wall, have a characteristic doughy consistency.
Diagnosis of meconium ileus
The diagnosis is considered in neonates with signs of intestinal obstruction, especially if there is a family history of cystic fibrosis. Patients should have abdominal radiography, which will show distended bowel loops and sometimes horizontal levels (at the air-fluid interface). A "soap bubble" pattern due to small air bubbles mixed with meconium is diagnostic of meconium ileus. If the infant has developed meconium peritonitis, calcified lumps of meconium may be located on the peritoneal surface and even in the scrotum. Barium studies reveal a microcolon with obstruction of the terminal ileum.
Patients diagnosed with meconium ileus should be evaluated for cystic fibrosis.
Treatment of meconium ileus
In uncomplicated cases (eg, without perforation, volvulus, or intestinal atresia), the obstruction may be relieved by one or more administrations of dilute acetylcysteine radiocontrast under fluoroscopy; less dilute (hypertonic) contrast may cause large fluid losses requiring intravenous infusion. If enemas fail to provide relief, laparotomy is necessary. Double ileostomy with repeated administration of acetylcysteine in the proximal and distal loops is usually necessary to liquefy and remove the meconium.
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