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Virtual Pediatric Hospital: Paediapaedia: Meconium Plug (Small Left Colon Syndrome) Paediapaedia: Gastrointestinal Diseases

Meconium Plug (Small Left Colon Syndrome)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Generalized abdominal distension, failure to pass meconium, and delayed onset of vomiting. Seen classically in infants of diabetic mothers or mothers who have received magnesium sulfate for preeclampsia during pregnancy.

Etiology/Pathophysiology:
Ganglion cells are present but immature and this causes a functional colonic inertia which leads to a meconium plug forming in the colon, that causes obstruction and a narrowed descending colon. A certain percentage of these patients also have Hirschsprung disease, so they must be followed closely to see if they develop symptoms of chronic constipation and require a rectal biopsy to rule out Hirschsprung Disease.

Pathology:
Present, but functionally immature ganglion cells.

Imaging Findings:
An enema shows a normal sized rectum and small caliber sigmoid and descending colon with a transition zone in colonic caliber occurring at the level of the splenic flexure. The meconium plugs are often outlined by the enema contrast material.The enema is most often curative.

DDX:
Low Bowel Obstruction

References:
See References Chapter.

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