Current significance of meconium plug syndrome

Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Journal of Pediatric Surgery (Impact Factor: 1.39). 06/2008; 43(5):896-8. DOI: 10.1016/j.jpedsurg.2007.12.035
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The significance of meconium plug syndrome is dependent on the underlying diagnosis. The incidence of pathologic finding, particularly Hirschsprung's disease, contributing to the presence of these plugs, has been debated. However, there are little recent data in the literature. Therefore, we reviewed our experience with meconium plugs as a cause of abdominal distension to evaluate the associated conditions and incidence of Hirschsprung's disease.
We reviewed the records of newborns with meconium plugs found in the distal colon on contrast enema from 1994 to 2007. Demographics, radiologic findings, histologic findings, operative findings, and clinical courses were reviewed.
During the study period, 77 patients were identified. Mean gestational age was 37.4 weeks and birth weight, 2977 g. Hirschsprung's disease was found in 10 patients (13%). One had ultrashort segment disease and another had total colonic aganglionosis. Maternal diabetes was identified in 6 patients. No patients were diagnosed with cystic fibrosis, meconium ileus, malrotation, or intestinal atresia.
Meconium plugs found on contrast enema are associated with a 13% incidence of Hirschsprung's disease in our experience. Although all patients with plugs and persistent abnormal stooling patterns should prompt a rectal biopsy and genetic probe, the incidence of Hirschsprung's and cystic fibrosis may not be as high as previously reported.

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    • "Meconium plug syndrome is a related but distinct entity characterized by colonic obstruction by inspissated meconium. It is usually benign, resolves with contrast enema administration, and is not usually associated with cystic fibrosis [10]. In turn, a distinction must be made between this condition and small left colon syndrome, which is associated with maternal diabetes, but also typically resolves with rectal contrast administration [11]. "
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