eMedicine Specialties > Radiology > Pediatrics

Meconium Plug Syndrome: Follow-up

Author: Michael J Diament, MD, Associate Professor, Department of Radiology, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: May 12, 2009

Intervention

In addition to contributing to diagnosis, contrast enema may be therapeutic.5 In most patients, the enema probably speeds what otherwise may be a slower spontaneous recovery.

Historically, Gastrografin, a hypertonic solution containing both wetting and detergent agents, was employed for contrast. However, complications secondary to hyperosmolarity occurred that produced dehydration. Evidence exists that the detergent and wetting additives may be toxic, and their possible therapeutic effect remains unproven.

Current practice uses low-osmolar contrast, which is adequately radiopaque at iso-osmolar levels if a low-kV technique is used. No evidence exists that the newer low-osmolar agents are less therapeutic than hyperosmolar media.

Contrast enema technique

  • Perform the enema with attention to the delicate temperature stability of the newborn infant. Use blankets and lamps and warm the contrast to body temperature.
  • Advance a small-caliber soft, rubber catheter (10-14F) into the rectum using minimal lubricant. Hold the catheter in place primarily by taping the patient's buttocks tightly together.
  • Some radiologists deploy a small Foley balloon (5 mL) to aid contrast retention. However, do not inflate the balloon until a preliminary injection of a small amount of contrast under fluoroscopy demonstrates adequate caliber of the rectum. Initial injection without an inflated balloon also assesses for a possible low-transition zone in patients with Hirschsprung disease.
  • Because the internal volume of the colon may be low, at the author's institution, contrast is injected by hand using a syringe under careful and almost continuous fluoroscopic monitoring. Others use a low-capacity reservoir, such as an intravenous bag, and infuse via gravity drip.
  • Opacify the entire colon both to maximize the therapeutic effect of the enema and to identify the position of the cecum.
  • Carefully attempt to reflux contrast into the distal ileum in patients who may have meconium ileus.
  • After the colon has been filled and the appropriate films obtained, remove the catheter without attempting to drain the colon. Allowing the patient to expel the contrast may help dislodge the meconium plug.

Response to the enema often is dramatic, with immediate passage of meconium and resolution of intestinal dilatation. In some patients, clinical findings persist and a second enema is performed for therapy. Since the plug is a symptom in this disorder, rather than its cause, little justification is found for multiple repeat procedures.

Special Concerns

  • The primary complication of this disorder is intestinal perforation, which may be spontaneous or secondary to overdistention during an enema.
  • Iatrogenic complications include fluid/electrolyte disorders resulting from hyperosmolar enema contrast and hypothermia from inadequate temperature control during the procedure.
 


More on Meconium Plug Syndrome

Overview: Meconium Plug Syndrome
Imaging: Meconium Plug Syndrome
Follow-up: Meconium Plug Syndrome
Multimedia: Meconium Plug Syndrome
References
Further Reading
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References

  1. Keckler SJ, St Peter SD, Spilde TL, Tsao K, Ostlie DJ, Holcomb GW 3rd, et al. Current significance of meconium plug syndrome. J Pediatr Surg. May 2008;43(5):896-8. [Medline].

  2. American Pediatric Surgical Association. Meconium Plug/Small Left Colon Syndrome. American Pediatric Surgical Association. Available at http://www.eapsa.org/parents/resources/plug.cfm. Accessed May 11, 2009.

  3. Burge D, Drewett M. Meconium plug obstruction. Pediatr SurgInternational. 2004;20(2):108-10. [Medline].

  4. American College of Radiology ACR Appropriateness Criteria. Vomiting in Infants up to 3 Months of Age. American College of Radiology. Available at http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonPediatricImaging/VomitinginInfantsupto3MonthsofAgeDoc11.aspx. Accessed May 12, 2009.

  5. American College of Radiology. ACR Practic Guideline for the Performance of Pediatric Fluoroscopic Contrast Enema Examinations. American College of Radiology. Available at http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/pediatric/pediatric_contrast_enema.aspx. Accessed May 12, 2009.

  6. Krasna IH, Rosenfeld D, Salerno P. Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant. J Pediatr Surg. Jun 1996;31(6):855-8. [Medline].

  7. McAlister WH, Kronemer KA. Emergency gastrointestinal radiology of the newborn. Radiol Clin North Am. Jul 1996;34(4):819-44. [Medline].

  8. Olsen MM, Luck SR, Lloyd-Still J. The spectrum of meconium disease in infancy. J Pediatr Surg. Oct 1982;17(5):479-81. [Medline].

  9. Sokal MM, Koenigsberger MR, Rose JS. Neonatal hypermagnesemia and the meconium-plug syndrome. N Engl J Med. Apr 13 1972;286(15):823-5. [Medline].

  10. Steves M, Ricketts RR. Pneumoperitoneum in the newborn infant. Am Surg. Apr 1987;53(4):226-30. [Medline].

  11. Swischuk LE. Meconium plug syndrome: a cause of neonatal intestinal obstruction. Am J Roentgenol Radium Ther Nucl Med. Jun 1968;103(2):339-46. [Medline].

  12. Wood BP, Katzberg RW. Tween 80/diatrizoate enemas in bowel obstruction. AJR Am J Roentgenol. Apr 1978;130(4):747-50. [Medline].

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Keywords

meconium plug syndrome, functional immaturity of the colon, small left colon syndrome, Hirschsprung disease

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Contributor Information and Disclosures

Author

Michael J Diament, MD, Associate Professor, Department of Radiology, University of California at Los Angeles School of Medicine
Michael J Diament, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Medical Editor

Beverly P Wood, MD, PhD, Professor Emerita, Departments of Radiology and Pediatrics, Division of Medical Education, Keck School of Medicine, University of Southern California; Professor of Clinical Radiology, Loma Linda University School of Medicine
Beverly P Wood, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

David A Stringer, BSc, MBBS, FRCR, FRCPC, Professor, National University of Singapore; Head, Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
David A Stringer, BSc, MBBS, FRCR, FRCPC is a member of the following medical societies: British Columbia Medical Association, Canadian Association of Radiologists, European Society of Paediatric Radiology, Ontario Medical Association, Radiological Society of North America, Royal College of Physicians and Surgeons of Canada, Royal College of Radiologists, and Society for Pediatric Radiology
Disclosure: Sirius d'innovation None Board membership

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

 
 
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