The medical term used to describe extremely thick meconium blocks in the last part of the baby’s small intestine (the ileum) is meconium ileus. Usually, this condition is a complication of cystic fibrosis, but it may also occur due to other causes. Doctors diagnose it by performing imaging tests. To treat this condition, physicians use enemas to flush the meconium out.
In other words, meconium ileus is a blockage in the newborn’s small intestine. A substance that is considered the first baby’s poop is called meconium. It is a substance thicker and stickier than normal poop that forms when the baby swallows amniotic fluid. Generally, amniotic fluid cushions the baby inside the womb during fetal development. When the amniotic fluid passes into the intestines, they may absorb a part of this fluid that contains meconium. In most cases, the baby passes stool in the amniotic fluid 48 hours before birth.
However, in babies who develop meconium ileus, this substance is abnormally thick or tar-like, and it blocks the last part of the small intestine. In such cases, the baby can experience abnormal swelling.
Types of Meconium Ileus
Physicians have divided this condition into 2 categories (simple or complex). Simple meconium ileus obstructs the last part of the small intestine, but they often do not experience complications. However, in babies with complex meconium ileus, the buildup of meconium in the intestine causes intense pressure and swelling. As a result, it may lead to serious complications. These include:
- Malrotation – This medical term is used to describe the baby’s intestine that does not develop properly. It often occurs due to prenatal volvulus, which means the small intestine twists around itself. Moreover, this is a serious complication, and without treatment, it may block the blood supply to the intestines.
- Intestinal atresia – When twisting blocks the baby’s blood supply to their intestine, this complication occurs. It means the baby’s intestine does not form completely.
- Perforation – This complication occurs when there is a hole in the baby’s intestinal wall. This is a life-threatening complication of complex meconium ileus, and it may cause meconium to leak into the baby’s abdominal cavity. In severe cases, meconium leakage may cause infection that leads to shock and death.
Symptoms
Usually, the most common symptom of meconium ileus is when the baby does not pass their first poop within 24 to 48 hours. Moreover, physicians are often able to feel large loops of small intestine through the abdominal wall. However, they may also experience other symptoms. These include:
- Breathing problems
- Fever
- Shock
- Tenderness
- Redness
- Vomiting
- Abdominal swelling
If any of the previous symptoms appear in your child, immediately contact your healthcare professional. Otherwise, it may lead to serious complications.
Causes and Risk Factors
In most cases, meconium ileus is a complication of cystic fibrosis. This is a genetic disorder in which the child’s intestinal secretions are abnormally thick and sticky. As a result, this substance sticks to the lining of the small intestine, causing blockages. In such cases, babies with meconium ileus may also experience symptoms of cystic fibrosis later in life.
Physicians have also identified some factors that may increase your child’s risk of developing meconium ileus. For example:
- Cystic fibrosis (approximately 80% of all diagnosed meconium ileus cases are caused by this condition)
- Low birth weight
- Maternal conditions – These include hypertension (high blood pressure), gestational diabetes, the use of certain medicines (such as steroids) during pregnancy, and others.
- Cesarean delivery – This procedure is often associated with an increased risk of meconium ileus.
- Fetal distress
- Gender – This condition mostly affects males more than females.
- Meconium plug syndrome
Complications and Prevention
Babies who develop this condition may also experience some complications, especially if it is left untreated. Check some complications below:
- Intestinal perforation and peritonitis – Blockages in the small intestine are often caused by extreme pressure that may lead to bowel ruptures. However, if the meconium enters the abdominal cavity, it may lead to severe chemical peritonitis.
- Volvulus – Sometimes, the intestines may twist and block blood flow to them. Without immediate treatment, it may lead to necrosis (tissue death) and gangrene.
- Meconium pseudocyst – This is a type of peritonitis that occurs when the body seals off the leaking meconium. Thus, there forms a walled-off, fluid-filled space with calcifications.
- Atresia – This complication indicates a blockage in the last part of the small intestine.
- Sepsis and shock – These are life-threatening complications that indicate widespread infection and systemic organ failure. In babies with meconium ileus, it may occur due to bacterial peritonitis.
- Cholestasis – In some cases, meconium ileus may affect liver function, especially if the baby receives total parenteral nutrition (TPN).
- Short bowel syndrome – This is a chronic (long-term) complication in which large sections of the intestine are surgically removed.
The previous list does not contain all possible meconium ileus complications, but you can consult with your doctor about measures to reduce the risk or prevent them. Furthermore, there is no way to prevent this condition because it is often caused by a genetic disorder (cystic fibrosis). That’s why doctors often recommend prenatal cystic fibrosis carrier screening before pregnancy. In general, it is very important to understand the risks of having children with cystic fibrosis.
Diagnosis
Sometimes, doctors diagnose meconium ileus during pregnancy on a prenatal ultrasound. This imaging test helps doctors see a blockage in the small intestine. Mostly, meconium ileus is diagnosed after birth based on the newborn’s symptoms. Usually, doctors consider meconium ileus if the baby has a family history of cystic fibrosis or tests positive for this disorder on their newborn screening tests. Check below some tests often used to diagnose meconium ileus:
- Imaging tests – Doctors often perform these tests to get detailed images of different structures and organs in the body. They often perform X-rays, ultrasounds, and CT (computed tomography) scans.
- Contrast enemas – These procedures are used to get detailed images of the large intestine on an X-ray test. Doctors often identify malrotation during this test. When this complication is found by doctors, they may also perform an upper gastrointestinal (UGI) test to confirm the diagnosis.
- A sweat test – This test helps confirm or rule out cystic fibrosis.
Treatment
Doctors often recommend different treatments for babies with meconium ileus. Check some of them below:
- Enema – In babies with the simple type of this condition, doctors use enemas to wash out the intestinal obstruction. During this treatment, doctors will slowly infuse the solution through a catheter that is inserted into the baby’s rectum. After that, they will use an imaging test (fluoroscopy) to create a real-time video of tissues inside the baby’s body.
- Ileostomy – If an enema does not help, doctors may recommend surgery to remove the meconium. During this procedure, surgeons will remove this sticky substance from the baby’s intestine through a cut in the abdominal wall.
Frequently Asked Questions
Who does meconium ileus affect?
According to some studies, meconium ileus occurs in about 90% of babies who already have cystic fibrosis.
What is the prognosis if my baby has meconium ileus?
In general, the prognosis is good among babies with meconium ileus. However, most of the time it occurs due to cystic fibrosis. Furthermore, if the condition is left untreated, it may lead to serious complications (including death).
Is meconium ileus an emergency?
While babies with simple meconium ileus may not need treatment, if your baby develops the complex type of the disease, immediate surgery is recommended. Otherwise, it may lead to life-threatening health problems (such as peritonitis or sepsis). If you have additional questions, ask your healthcare provider.
