Diagnosis
The radiologically performed x-ray of the abdomen in a hanging position shows intestinal loops in the meconium ileus, which is located at the transition from the small to the large intestine, in the area before the intestinal obstruction. The bubble-like pattern results from the mixing of air with the viscous meconium and is called Neuhauser’s sign. In most cases no mirroring is visible.
The colon appears very narrow (so-called microcolon). If fluid levels are visible in the X-ray image, this is an indication of atresia or volvulus (rotation of the intestine around its own axis) and not an indication of a meconium ileus caused by cystic fibrosis. A peritonitis that existed before birth is visible in the X-ray image through small calcifications.
The meconium ileus can be diagnosed by means of an x-ray. An image of the intestine is taken for this purpose. This shows fluid-filled intestinal loops, which are more voluminous than in healthy newborns.
Therapy
If a meconium ileus is detected in a newborn baby, a gastrografin enema is performed under x-ray examination in patients with good fluid balance. Gastrografin is a contrast agent for imaging the gastrointestinal tract, which is used to better monitor the procedure. The enema causes the obstructed section of the intestine to be slightly stretched, which allows the meconium to detach from the intestinal wall.
If meconium is transported out of the intestine through the enema, the enema should be continued to transport even more meconium out of the intestine. It may take several enemas over several days to loosen the ileus and completely remove the meconium, but Gastrografin enemas are successful in about 50% of cases of uncomplicated meconium ileus without perforation or other complications. Possible complications of a Gastrografin enema are perforations of the intestine that require surgical treatment.
If the gastrografin enema fails to transport a sufficient amount of meconium out of the bowel, the meconium must be removed in a surgical procedure. In the case of an uncomplicated meconium ileus, a small incision in the affected section of the intestine with subsequent removal and rinsing of the viscous meconium is sufficient. In rare cases, an artificial bowel outlet must be created temporarily, which can be relocated after a while.
In the case of a complicated meconium ileus, it is usually necessary to remove parts of the intestine and to suture the two emerging ends together again. After such an operation, newborns have to be cared for in the intensive care unit for some time and receive parenteral nutrition via the vein for the first time until intestinal function has normalized. In the case of a complicated meconium ileus, it is usually necessary to remove parts of the intestine and to suture the two emerging ends together again. After such an operation, newborns have to be cared for in the intensive care unit for some time and receive parenteral nutrition via the vein for the time being until intestinal function has normalized.