Purpose or Case Report: Neonatal bowel obstruction (NBO) is the first presentation of cystic fibrosis (CF) in approximately 15–20% of cases and is most commonly due to meconium ileus (MI) in this cohort. Contrast enema (CE) is a diagnostic tool which can help discern NBO etiology with variable accuracy. CE can also be a therapeutic tool in cases of simple MI. In this study, we describe our experience with CE in diagnosis and management of meconium ileus and other pathologies causing bowel obstruction in these patients.
Methods & Materials: We performed a retrospective review of infants with CF less than 60-days-old who underwent CE for NBO workup from 2006-2022. We reviewed the electronic medical record and captured clinical, pathology and operative details. The enema studies were reviewed by a pediatric radiologist. We defined a diagnosis of MI based on intraoperative findings or CE findings of microcolon and reflux to distended distal, meconium-filled ileal loops. We defined meconium plugging as CE with normal caliber colon filled with meconium and relieved by enema, small left colon syndrome (SLCS) as a small caliber left colon with normal caliber remaining colon and rectum, and Hirschsprung’s disease as the absence of ganglion cells in rectal biopsy specimens. We used descriptive statistics to report clinical and radiographic findings.
Results: We included a total of 35 neonates (22 males and 13 females). Twenty-seven patients (77.1%) had MI while eight patients (22.9%) had other diagnoses: intestinal atresia (n=1), Hirschsprung’s disease (n=2), small left colon syndrome (n=2), and meconium plug (n=3). The key for diagnosis of MI was reflux of contrast to distended ileal loops filled with meconium, which was achieved in only 7 (25.9%) patients. CE could not differentiate between simple (n=14) and complicated MI (n=13) and was both diagnostic and therapeutic in only one patient with simple MI. Enema suggested Hirschsprung’s disease in two patients which was confirmed by pathology.
Conclusions: CE was helpful for providing alternate diagnoses in 22.9% of patients with CF and NBO but confirmed the diagnoses of MI in only 26% of patients that had reflux of contrast to the distal ileal loops. CE was not able to differentiate between simple and complex MI and was therapeutic for simple MI in only one patient.