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Meconium Plug Syndrome

(Small Left Colon Syndrome)


William J. Cochran

, MD, Geisinger Clinic

Last review/revision Aug 2021 | Modified Sep 2022
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Meconium plug syndrome is colonic obstruction caused by thick meconium. Diagnosis is based on radiographic contrast enema and sometimes testing for Hirschsprung disease. Treatment is radiographic contrast enema; surgical decompression is rarely required.

Meconium plug syndrome usually occurs in infants who are otherwise healthy and has an incidence of 1 in 500 live births. It is generally regarded as a functional immaturity of the colon, resulting in failure to pass the first stool.

Etiology of Meconium Plug Syndrome

Meconium plug syndrome is more common among

Etiology reference

  • 1. Buonpane C, Lautz TB, Hu YY: Should we look for Hirschsprung disease in all children with meconium plug syndrome? J Pediatr Surg 54(6):1164, 2019. doi: 10.1016/j.jpedsurg.2019.02.036

Symptoms and Signs of Meconium Plug Syndrome

Infants present in the first few days of life with failure to pass stools, abdominal distention, and vomiting. Thick, inspissated, rubbery meconium forms a cast of the colon, resulting in complete obstruction.

Diagnosis of Meconium Plug Syndrome

  • Radiographic contrast enema

  • Sometimes testing for Hirschsprung disease

Plain abdominal x-rays are nonspecific and can show signs of low intestinal obstruction. Conversely, contrast enema shows the characteristic appearance of the outline of the inspissated meconium against the wall of the colon, providing a double-contrast impression. Unlike meconium ileus Diagnosis Meconium ileus is obstruction of the terminal ileum by abnormally tenacious meconium; it most often occurs in neonates with cystic fibrosis. Meconium ileus accounts for up to 33% of neonatal... read more , microcolon is not typically seen on x-ray with meconium plug syndrome.

Treatment of Meconium Plug Syndrome

  • Radiographic contrast enema

The water-soluble contrast enema can be therapeutic by separating the plug from the intestinal wall and expelling it. Occasionally, repeated enemas are required.

Rarely, surgical decompression is required. Although most infants are healthy thereafter, diagnostic studies may be needed to rule out Hirschsprung disease or cystic fibrosis.

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