Bilious Emesis and Failure to Pass Meconium in the Nursery: A Case Study

Area of Science:

• Pediatric Surgery
• Neonatal Medicine
• Gastroenterology

Background:

• Neonatal intestinal obstruction is a rare but serious condition requiring prompt diagnosis and management.
• Small left colon syndrome is a functional immaturity of the colon causing distal obstruction.
• Meconium plug syndrome, a cause of neonatal obstruction, can mimic other conditions.

Observation:

• A neonate born to a COVID-19 positive mother presented with failure to pass meconium.
• Following glycerin suppository administration, the infant developed bilious emesis and abdominal distention.
• Imaging revealed a distal obstruction, later identified as a meconium plug.

Findings:

• The case highlights small left colon syndrome presenting as a meconium plug.
• Rectal irrigation successfully removed the meconium plug, relieving the obstruction.
• The meconium plug's appearance on imaging mimicked the descending colon.

Implications:

• Early recognition and intervention for meconium plug syndrome are crucial in neonates.
• Failure to relieve distal obstruction can lead to severe complications like intestinal perforation.
• This case underscores the importance of considering functional immaturity in neonatal bowel obstruction.