eMedicine Specialties > Pediatrics: Surgery > General Surgery

Small Left Colon Syndrome: Workup

Author: Erik Skarsgard, MD, Associate Professor of Surgery, Division of Pediatric Surgery, University of British Columbia, Children's and Women's Health Center of British Columbia
Coauthor(s): Geoffrey Blair, MD, Clinical Professor of Pediatric General Surgery, Department of Pediatric Surgery, University of British Columbia; Head, British Columbia's Children's Hospital
Contributor Information and Disclosures

Updated: Sep 30, 2008

Workup

Laboratory Studies

Perform basic laboratory investigations, including complete CBC count and differential, C-reactive protein, coagulation profiles, and blood cultures. Measure serum levels of glucose, calcium, and magnesium in infants of mothers with diabetes mellitus or eclampsia or in infants who otherwise appear stressed. Cross-matched blood should be available.

Imaging Studies

Two-view abdominal radiography should be promptly performed. Typically, distal intestinal obstruction with air-fluid levels is revealed (see Media file 1). Occasionally, infants (especially those in whom the recognition of intestinal obstruction has been delayed) have pneumoperitoneum on plain film radiography, which may be the result of a cecal perforation.

Other Tests

Because Hirschsprung disease with a splenic flexure transition zone is clinically and radiologically indistinguishable from neonatal small left colon syndrome (NSLCS), all infants must have a suction rectal biopsy performed to exclude aganglionosis. Cystic fibrosis that produces a colonic variant of meconium ileus should be considered, and the appropriate DNA testing should be performed, as well as a sweat chloride test when the infant is older, if appropriate.10

Diagnostic Procedures

If plain film radiography does not reveal perforation, the infant should undergo a contrast enema examination, usually with a water-soluble medium. Because the choice of contrast medium and experience with neonatal conditions are critical to the interpretive accuracy and safety of the examination, the contrast enema examination should be performed by a radiologist who has pediatric expertise.

The diagnosis of neonatal small left colon syndrome on contrast enema examination is based on the following fluoroscopic findings: (1) proximal dilation of colon (and, to a lesser extent, small bowel) with abundant intraluminal meconium; (2) an abrupt cone-shaped caliber transition at or just distal to the splenic flexure; and (3) a constricted but smooth contoured, and often foreshortened, descending and sigmoid colon devoid of meconium with a slightly larger caliber rectum (see Media file 2).

More on Small Left Colon Syndrome

Overview: Small Left Colon Syndrome
Workup: Small Left Colon Syndrome
Treatment: Small Left Colon Syndrome
Follow-up: Small Left Colon Syndrome
Multimedia: Small Left Colon Syndrome
References
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References

  1. Davis WS, Allen RP, Favara BE, Slovis TL. Neonatal small left colon syndrome. Am J Roentgenol Radium Ther Nucl Med. Feb 1974;120(2):322-9. [Medline].

  2. Philippart AI, Reed JO, Georgeson KE, Slovis TL. Neonatal small left colon syndrome: intramural not intraluminal obstruction. J Pediatr Surg. Oct 1975;10(5):733-40. [Medline].

  3. Schofield DE, Yunis EJ. Intestinal neuronal dysplasia. J Pediatr Gastroenterol Nutr. Feb 1991;12(2):182-9. [Medline].

  4. Burge D, Drewett M. Meconium plug obstruction. Pediatr Surg Int. Feb 2004;20(2):108-10. [Medline].

  5. Berdon WE, Slovis TL, Campbell JB, et al. Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome. Radiology. Nov 1977;125(2):457-62. [Medline].

  6. Rangecroft L. Neonatal small left colon syndrome. Arch Dis Child. Aug 1979;54(8):635-7. [Medline].

  7. Stewart DR, Nixon GW, Johnson DG, Condon VR. Neonatal small left colon syndrome. Ann Surg. Dec 1977;186(6):741-5. [Medline].

  8. Woodhurst WB, Kliman MR. Neonatal small left colon syndrome: report of two cases. Am Surg. Jul 1976;42(7):479-81. [Medline].

  9. Falterman CG, Richardson CJ. Small left colon syndrome associated with maternal ingestion of psychotropic drugs. J Pediatr. Aug 1980;97(2):308-10. [Medline].

  10. Ellerbroek C, Smith WL. Neonatal small left colon in an infant with cystic fibrosis. Pediatr Radiol. 1986;16(2):162-3. [Medline].

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

  12. 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].

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Further Reading

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Keywords

small left colon syndrome, neonatal small left colon syndrome, NSLCS, imperforate anus, colonic atresia, colonic stenosis, Hirschsprung disease, colonic obstruction, gestational diabetes mellitus, meconium plug, dysmotility syndrome, hypoglycemia, constipation, enterocolitis, infants of diabetic mothers, cystic fibrosis, eclampsia, abdominal distension, intestinal perforation

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Contributor Information and Disclosures

Author

Erik Skarsgard, MD, Associate Professor of Surgery, Division of Pediatric Surgery, University of British Columbia, Children's and Women's Health Center of British Columbia
Erik Skarsgard, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Geoffrey Blair, MD, Clinical Professor of Pediatric General Surgery, Department of Pediatric Surgery, University of British Columbia; Head, British Columbia's Children's Hospital
Geoffrey Blair, MD is a member of the following medical societies: American Pediatric Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert Kelly, MD, Chairman, Department of Surgery, Departments of Surgery and Pediatrics, Children's Hospital of the King's Daughters; Associate Professor, Eastern Virginia Medical School
Robert Kelly, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Abdominal Surgeons, Medical Society of Virginia, Norfolk Academy of Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Deborah F Billmire, MD, Associate Professor, Department of Surgery, Indiana University Medical Center
Deborah F Billmire, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Phi Beta Kappa, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Harsh Grewal, MD, FACS, FAAP, Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University Children's Medical Center
Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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