Meconium plug syndrome

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Classification according to ICD-10
P76.0 Meconium plug syndrome
ICD-10 online (WHO version 2019)

The Mekoniumpfropfsyndrom is a functional intestinal obstruction in newborns . This is a temporary delay in the excretion of meconium with expansion of the small intestine. The left half of the colon (descending colon) is reduced in diameter and thus belongs to the small left colon syndrome .

Synonyms are: English functional immaturity of the colon; colonic immaturity; small left colon syndrome; functional colonic obstruction

The first description comes from the year 1905 by Karl Landsteiner .

distribution

The frequency is given as 1 in 1000 births. There is an association with Hirschsprung's disease and cystic fibrosis, as well as gestational diabetes .

root cause

A temporary dysfunction of the large intestine, an abnormal composition (with no proven cystic fibrosis) and a reduced water content of the meconium are suspected to be the cause.

The syndrome is not identical to the small left colon syndrome .

Clinical manifestations

The clinical picture is practically identical to that of the meconium ileus . However, a complete normalization takes place after successful emptying. Clinical criteria are:

  • bilious vomiting shortly after birth
  • sparse to absent meconium waste
  • distended abdomen, possibly loops of intestine visible under the abdominal wall (intestinal stiffening)

diagnosis

The diagnosis is based on anamnesis , clinical and imaging examination. The X-ray overview of the abdomen shows signs of a deep ileus with a deflated pelvis. Often the rectal examination , or at the latest the colonic contrast enema , can empty the meconium. The size of the large intestine usually increases from the rectosigmoid towards the mouth.

Differential diagnosis

Other causes of deep intestinal obstruction such as meconium ileus, Hirschsprung's disease or deep intestinal atresia (ileum atresia), intestinal stenosis, distal intestinal obstruction syndrome (meconium ileus equivalent syndrome), necrotizing enterocolitis or functional pseudo-obstruction are to be distinguished. Therefore, anorectal manometry and a serial suction biopsy are recommended

therapy

Treatment is done through enemas.

Healing prospects

The prognosis is very good.

Individual evidence

  1. ↑ a b c d e Bernfried Leiber (founder): The clinical syndromes. Syndromes, sequences and symptom complexes . Ed .: G. Burg, J. Kunze, D. Pongratz, PG Scheurlen, A. Schinzel, J. Spranger. 7., completely reworked. Edition. tape 2 : symptoms . Urban & Schwarzenberg, Munich et al. 1990, ISBN 3-541-01727-9 .
  2. ↑ a b emedicine
  3. ↑ a b c Radiopaedia
  4. ↑ K. Landsteiner: Intestinal obstruction by thickened meconium. In :: Pancreatitis, Central Sheet for General Pathology and Pathological Anatomy. Vol. 16, 1905, p. 903.
  5. ↑ a b W. Schuster, D. Färber (editor): Children's radiology. Imaging diagnostics. 2nd edition, Springer 1996, ISBN 3-540-60224-0 , p. 549
  6. ↑ a b c Marcel Bettex (ed.), Max Grob (introduction), D. Berger (arrangement), N. Genton, M. Stockmann: Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd, revised edition, Thieme, Stuttgart / New York 1982, ISBN 3-13-338102-4 , p. 7.58
  7. ↑ IH Krasna, D. Rosenfeld, P. Salerno: Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant. In: Journal of pediatric surgery. Volume 31, Number 6, June 1996, pp. 855-858, doi: 10.1016 / s0022-3468 (96) 90153-0 , PMID 8783123 .
  8. ↑ HH Cho, JE Cheon, YH Choi, SM Lee, WS Kim, IO Kim, SM Shin, EK Kim, HS Kim, JH Choi, SK You: Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success. In: European journal of radiology. Volume 84, number 10, October 2015, pp. 2024–2031, doi: 10.1016 / j.ejrad.2015.06.006 , PMID 26159485 .