CAPS original papers
Current significance of meconium plug syndrome

https://doi.org/10.1016/j.jpedsurg.2007.12.035Get rights and content

Abstract

Background

The significance of meconium plug syndrome is dependent on the underlying diagnosis. The incidence of pathologic finding, particularly Hirschsprung's disease, contributing to the presence of these plugs, has been debated. However, there are little recent data in the literature. Therefore, we reviewed our experience with meconium plugs as a cause of abdominal distension to evaluate the associated conditions and incidence of Hirschsprung's disease.

Methods

We reviewed the records of newborns with meconium plugs found in the distal colon on contrast enema from 1994 to 2007. Demographics, radiologic findings, histologic findings, operative findings, and clinical courses were reviewed.

Results

During the study period, 77 patients were identified. Mean gestational age was 37.4 weeks and birth weight, 2977 g. Hirschsprung's disease was found in 10 patients (13%). One had ultrashort segment disease and another had total colonic aganglionosis. Maternal diabetes was identified in 6 patients. No patients were diagnosed with cystic fibrosis, meconium ileus, malrotation, or intestinal atresia.

Conclusion

Meconium plugs found on contrast enema are associated with a 13% incidence of Hirschsprung's disease in our experience. Although all patients with plugs and persistent abnormal stooling patterns should prompt a rectal biopsy and genetic probe, the incidence of Hirschsprung's and cystic fibrosis may not be as high as previously reported.

Section snippets

Methods

Retrospective review of the medical record was performed on all patients diagnosed with a meconium plug identified in the rectum on contrast enema from January 1994 through February 2007. During the study timeframe, 77 patients were identified. Gestational age, birth weight, passage of meconium, bilious vomiting, abdominal distension, associated anomalies, and maternal diabetes were recorded. The presence of meconium ileus, small descending colon, a transition zone, malrotation, and intestinal

Results

Mean estimated gestational age was 37.4 ± 2.4 weeks with a mean birth weight of 2977 ± 693 g. Sex distribution included 48 males and 29 females. Abdominal distension followed by bilious emesis was the most common clinical presentation. A history of maternal diabetes was present in 6 patients (7.8%). Mean age at presentation was 1.49 ± 0.92 days. Spontaneous passage of meconium in the first 24 hours occurred in 15 patients (19.5%). No cases of meconium ileus or intestinal atresia were

Discussion

The term meconium plug syndrome was first reported by Clatworthy [1] in 1956 to describe the colonic obstruction because of inspissated meconium. Initial nonsurgical management was recommended as most of these patients were treated effectively with rectal stimulation or contrast enema. This original report was later updated with additional patients 10 years later, in which the authors recommended rectal biopsy to rule out Hirschsprung's disease if normal bowel function did not occur after

References (8)

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Presented at the 39th Annual Meeting of the Canadian Association of Pediatric Surgeons, August 23-26, 2007, St John's Newfoundland, Canada.

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