American Pediatric Surgical Association :: Resources : Meconium Plug/Small Left Colon Syndrome

Although meconium plug and neonatal small left colon syndromes share sufficient similarities to be discussed together. Patients have transient colonic obstruction most likely due to poor function. The principles of diagnosis and management are similar. The important distinction in the recognition of these syndromes is that they are associated with colonic obstruction, as differentiated from the picture seen with meconium ileus, in which the small intestine is involved. Although emphasis previously has been placed on the theory that meconium plug and small left colon syndromes result from obstruction of the colon by abnormal meconium, it is more likely that these disorders result from transient disorders of bowel function related to immaturity.

FIGURE 62-5 A, Barium enema study shows the classic findings of meconium plug syndrome. Even though the distal colon was collapsed on film, when the plug was evacuated, bowel movements were normal, and a suction rectal biopsy specimen showed ganglion cells to be present. B, Barium enema study in a newborn (whose mother was diabetic) who failed to stool within 48 hours of birth shows the typical findings of neonatal small left colon syndrome. This is not Hirschsprung’s disease but most likely a temporary motility disorder that will resolve in a few days.

These infants present with abdominal distention, bile-stained vomiting, and failure to pass any stool during the first 1 to 2 days of life. In more than 50% of patients with small left colon syndrome, the mother has a history of diabetes. Plain xrays of the abdomen show massively enlarged intestine. Contrast enemas characteristically show an enlarged colon at varying levels with meconium plug syndrome and characteristically at the splenic flexure in small left colon syndrome. Patients typically improve after the xray contrast enema, particularly if water-soluble contrast material is used. Occasionally the enema may need to be repeated.

Ordinarily, xray contrast enemas relieve patients with either of these disorders. Surgery rarely is required except in unusual instances in which perforation may have occurred. In infants of diabetic mothers, appropriate perinatal management of low glucose may be necessary. Because the clinical and radiographic picture is similar to that of Hirschsprung’s disease, suction biopsy of the rectum may be required to rule it out. Provided that the infant does not have Hirschsprung’s disease, there are no long-term complications. CF initially may manifest itself with a meconium plug, so infants should be evaluated for CF.