Meconium Ileus: Causes, Diagnosis, Treatment

 

Meconium ileus occurs when the last part of your newborn's small intestine, known as the ileum, is blocked by very thick meconium. 

Overview:

Meconium ileus occurs when very thick meconium blocks the last part of the small intestine of your newborn. This last part of the intestine is called the ileum. Meconium ileus often happens because of cystic fibrosis. Your healthcare provider can diagnose this condition using imaging tests. The treatment varies based on how severe the condition is but usually includes using enemas to clear the meconium.

What is meconium ileus?

Meconium ileus is a condition where the last part of your newborn's small intestine, called the ileum, is blocked by very thick meconium, which is the baby's first stool. This blockage often occurs as a result of cystic fibrosis. Meconium is stickier than normal poop, darker in color, and thicker in consistency, it forms when your newborn swallows amniotic fluid.

How does blockage occur?

If your baby's meconium is unusually thick or tar-like, it can obstruct the last portion of the small intestine known as the ileum. This blockage causes the small intestine above the ileum to expand, resulting in abdominal swelling. Meanwhile, below the ileum, the large intestine of your newborn will narrow down to its usual size. To put it simply, using too much toilet paper can clog the toilet, preventing anything from passing through the pipes and causing waste and water to build up.

What is amniotic fluid?

Amniotic fluid is a liquid that protects and supports the developing baby in the uterus. As the fluid moves through your baby's digestive system, it absorbs the water and nutrients from it. This leaves a sticky, tar-like substance called meconium. Generally, babies pass their first bowel movement within 24 to 48 hours after birth.

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Who does meconium ileus affect?

Meconium ileus is a condition that is often caused by cystic fibrosis. About 10% to 20% of children with cystic fibrosis experience meconium ileus as their first symptom of the disease. Moreover, studies have revealed that up to 90% of infants diagnosed with meconium ileus have cystic fibrosis.

How many types are there of meconium ileus?

Meconium ileus is typically classified into two types:

1. Simple meconium ileum:

Simple meconium ileus refers to the isolated obstruction of the small intestine by thick meconium. This type of meconium ileus does not involve additional complications beyond the blockage itself.

2. Complex meconium ileus:

Complex meconium ileus, also known as complicated meconium ileus, involves additional complications beyond the blockage of the small intestine by thick meconium. These complications may include issues such as perforation or volvulus.

Complex meconium ileus may lead to severe complications that may include:

1. Intestinal atresia: If a baby's intestine is twisted and the blood supply is blocked, it can cause intestinal atresia, which means that certain parts of the small intestine will not form completely.
2. Malrotation: Malrotation occurs when the intestine twists around itself, blocking blood supply. This can happen due to prenatal volvulus.
3. Perforation: Perforation is a condition where a hole develops in the baby's intestine and can cause meconium to leak into the abdominal cavity resulting in infection, shock, and death.

Symptoms:

What are the symptoms of meconium ileus?

If a newborn does not pass their first bowel movement within 24 to 48 hours, it may indicate meconium ileus. Other indications of meconium ileus include vomiting and abdominal swelling, which can make it difficult for the baby to breathe. Your child's healthcare provider may be able to feel large loops of small intestine through their abdominal wall. If your baby has a perforated intestine, they may also develop further complications such as:

• Tenderness
• Redness
• Shock
• Fever

Causes:

What causes meconium ileus?

Meconium ileus is often an initial indication of cystic fibrosis. which is a genetic disorder that causes your child's digestive secretions to be thicker and stickier than usual. These secretions cling to the walls of your child's intestine, causing blockages. If your child is diagnosed with meconium ileus, they may be prone to experiencing other symptoms of cystic fibrosis later in their life.

Diagnosis:

How is meconium ileus diagnosed?

Meconium ileus can be diagnosed before birth through prenatal ultrasound if any signs of blockage are present. However, it is more commonly diagnosed after birth based on the symptoms your newborn is exhibiting. The healthcare provider will consider meconium ileus if your newborn is experiencing symptoms associated with the condition.

• Your newborn tests positive for cystic fibrosis on their newborn screening tests
• Cystic fibrosis runs in your family.

Tests:

What tests will be conducted to diagnose meconium ileus?

If your baby's healthcare provider suspects that your baby has meconium ileus, they will order an abdominal X-ray. This will help to identify any enlarged loops in your baby's small intestine. If meconium mixes with swallowed air, it can create the appearance of soap bubbles in the small intestine on the X-ray. If there is a complete obstruction, there will be no air present in your baby's rectum.

The radiology department may also perform a contrast enema, where a liquid that's visible on X-rays is used. This enema can show if your baby's large intestine is narrower than normal or identify malrotation. If malrotation is detected, your baby's healthcare provider will order an upper gastrointestinal series (UGI) which can confirm the diagnosis. A UGI can also help evaluate where the intestine is twisting.

Finally, your baby's healthcare provider may suggest a sweat test to confirm cystic fibrosis.

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Treatment:

How is meconium ileus treated?

If your newborn is suffering from complex meconium ileus, which may include a twisted or perforated intestine, it will require immediate surgery. However, if your baby has simple meconium ileus, the healthcare provider may try to wash out the blockage using an enema. This enema may consist of a special drug that can soften and break down the thick meconium, allowing it to pass through the baby's intestine and out of the rectum.

To administer the enema, the healthcare provider will slowly infuse the solution through a catheter that has been inserted into your baby's rectum. This process will be monitored using a medical imaging technique called fluoroscopy. Fluoroscopy uses X-rays to produce a live video of the internal tissues in your baby's body.   

If the enema fails to work, the healthcare provider will have to perform surgery. During the surgery, the doctor will cut the baby's intestine and remove the meconium. Depending on the baby's condition, the doctor may bring the open ends of the baby's intestine out through the wall of the abdomen, creating an ileostomy. More enemas will be administered through the open ends until all the meconium is removed. Finally, another operation will be performed to reconnect the ends of the baby's intestine.

Prevention

How can I prevent meconium ileus in my baby?

You can't stop meconium ileus. Cystic fibrosis usually causes this problem, and it's a disease that is passed down in families. If you are conceived or planning it, you should get tested to see if you carry the gene for cystic fibrosis. This test can help you know the chances of having a baby with this problem.

What is the difference between a meconium plug and an ileus?

The main difference between meconium plug and meconium ileus lies in their underlying causes and effects. Meconium plug is a condition where the passage of meconium (a newborn's first stool) is obstructed in the lower intestine, often due to factors such as immaturity of the intestines or dehydration. On the other hand, meconium ileus is a condition typically associated with cystic fibrosis, where the meconium becomes thick and sticky, leading to an obstruction in the small intestine.

In summary, the meconium plug is primarily a physical obstruction in the lower intestine, while the meconium ileus is linked to cystic fibrosis and involves the obstruction of the small intestine due to the characteristics of the meconium.

What is the prognosis for babies with meconium ileus?

In simple terms, even when meconium ileus is complicated, the outlook is generally good. Meconium ileus often indicates cystic fibrosis. However, with early detection and treatment, your baby's long-term health in terms of lung function, nutrition, and infection risk is positive. If meconium ileus is not treated, the outlook for your baby is not good. It's crucial to get treatment promptly if your baby has meconium ileus.

What should I do if my baby has meconium ileus?

If your baby has meconium ileus, it's important to seek medical attention right away. Contact your baby's healthcare provider or go to the nearest hospital for a prompt evaluation and treatment. Early diagnosis and intervention are crucial for the best possible outcome. Additionally, discussing your concerns with the healthcare provider and following their guidance will help ensure the appropriate care for your baby.