MECONIUM ILEUS TREATMENT WITH ULTRASOUND GUIDED CONTRAST ENEMA

The inspissated meconium pellets are a cause or effect of ileocolic obstructions. The present study aimed at explaining our experience of an ultrasound-based approach for differentiation and treatment of the inspissated meconium pellets. This study was conducted at Mashhad University of Medical Sciences, Mashhad, Iran, from 2017-2021. Thirty neonates (less than 8 days) with inspissated meconium pellets were examined using ultrasound. Moreover, in cases with non-complicated inspissated meconium pellets, ultrasound-guided contrast enema was performed for confirmation of the diagnosis or probable treatment. In ultrasound, the inspissated meconium pellets were observed as uniform hypo- to hyper-echoic tubular or beaded intra-luminal material in ileocolic loops or recto-sigmoid area. These pellets were in five states: simple meconium ileus, complicated meconium ileus,  small bowel atresia, meconium plug syndrome, and hirschsprung’s disease.
During contrast enema in non-complicated meconium ileus, moving and floating of inspissated meconium pellets was observed during ultrasound scanning, while this issue was not observed in small bowel atresia. The success rates of the ultrasound guided contrast enema in patients with simple meconium ileus were 80%. The inspissated meconium pellets have an ultrasound appearance. they are mainly observed in patients with simple and complicated meconium obstructions and bowel atresia. Except in complicated meconium obstructions, the ultrasound-guided contrast enema was performed for their differentiation and probable treatment.