Purpose or Case Report: To summarize our experience in diagnosis neonatal bowel obstruction in cystic fibrosis (CF) patient using contrast enema study. This pictorial review will illustrate and discuss several aspects of imaging findings in non-complicated and complicated meconium ileus as well as the mimicker.

Key imaging findings, pearls and pitfalls in diagnosis and guided treatment will be made, emphasizing what radiologists need to know. Correlation with intraoperative findings and follow-up images will also be provided.
Methods & Materials: Using our radiology database, a retrospective review of barium enema studies in neonate with delayed pass meconium from 2010-2017 was obtained. Clinical data and imaging finding were reviewed. We will demonstrate imaging findings of non-complicated and complicated meconium ileus in CF neonate with delayed pass meconium, as microcolon secondary to meconium ileus, meconium plug, meconium peritonitis, colonic volvulus and ileal atresia. Imaging of the mimicker of meconium ileus will be discussed including microcolon secondary to very low birth weight and prematurity and total colonic Hirschsprung’s disease.

Imaging checklists for diagnosis and guided either therapeutic enema or surgery will be demonstrated.
Results: Delayed pass meconium is the first sign of neonatal bowel obstruction. Approximately 20% of neonates with CF present with meconium ileus or meconium plug syndrome at birth due to abnormally thick and impacted meconium at the distal ileum or left-sided colon. However in some patients, it can present with complications such as meconium peritonitis or colonic volvulus which need immediate surgical intervention.

Optimal imaging technique is important to generate a correct diagnosis and therapeutic treatment.
Conclusions: Contrast enema plays an important role in diagnosis and guided treatment in CF neonate with delayed pass meconium. Understanding imaging findings of non-complicated, complicated and mimicker of meconium ileus are crucial for radiologist to generate a correct diagnosis and guide treatment.