*Meconium Ileus DOI: http://dx.doi.org/10.5772/intechopen.85548*

*Pediatric Surgery, Flowcharts and Clinical Algorithms*

from fulminant colitis and dehydration sometimes reported with its use [28]. Also, the report of the Cystic Fibrosis Foundation Consensus Conference on gastrointestinal disorders concluded that there is no scientific evidence that hyperosmolar Gastrografin enema is any better than an iso-osmolar or hypo-osmolar enema. Nevertheless, many radiologists use it safely by ensuring appropriate dilution ratios. Adequate monitoring of fluid and electrolyte balance before, during, and after the contrast study is essential to avert potential fluid shifts with consequent hypovolemia which is worsened when bowel perforation and contrast leak occur. Nonionic contrast agents like Hypaque and Omnipaque are becoming popular with many radiologists since they have less risk of dehydration or colitis. Because of the tenacious and sticky nature of meconium, mucolytic agents like acetylcysteine are sometimes mixed with the contrast enema solution to aid passage of the meconium. Meconium peritonitis may be an incidental abdominal radiograph finding in which the extruded meconium may be calcified or the radiograph may only suggest fluid in the abdomen when no calcification is present. When the calcification appears amorphous and curvilinear suggesting cystic loculation of the peritoneum,

*Contrast enema showing microcolon and meconium pellets in the terminal ileum [courtesy Radiopaedia].*

Prenatal ultrasound scan done at 17–18 weeks gestational age may show signs suggestive of meconium ileus; this include enlarged bowel loops or a mass with proximal bowel distention (likely cystic meconium peritonitis) [11, 12]. Also, calcified meconium may be seen if meconium peritonitis has already occurred. Also

the term cystic or pseudocystic meconium peritonitis is used [5].

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**Figure 1.**

there might be polyhydramnios.

Postnatal ultrasound scan is seldom necessary for meconium peritonitis, as the findings on plain radiographs are usually diagnostic. However, ultrasonography may be useful when cystic masses are present. The cystic masses often appear circumscribed and heterogeneous with sonolucent areas seen within the cyst suggestive of fluid. They demonstrate increased echogenicity resulting from debris and calcifications, and loops of fluid-filled bowel bound to the matrix of the associated adhesions may be noted. The cyst wall may be thick or thin. Multiple speckled echoes are seen with free-floating meconium in the abdomen, and these result in the snowstorm configuration.

Zangheri et al. created the following classification system related to perinatal outcome [29]:


Patients diagnosed with meconium ileus should be tested for cystic fibrosis; the sweat chloride test should be done [25].
