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Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia
M R Neal1, J J Seibert, T Vanderzalm
1Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, USA.
Abstract:
Meconium ileus can be difficult to distinguish from ileal atresia on plain radiographs and on contrast enema. Both show a microcolon in the face of a small bowel obstruction. The treatment of the two is very different. Meconium ileus obstruction may be relieved medically by contrast enema; ileal atresia requires prompt surgical intervention. This study was made to determine if abdominal ultrasonography might be helpful in distinguishing between these two entities. Abdominal ultrasonograms from the past 10 years of all patients with these two diseases who were studied with preoperative ultrasonography at Arkansas Children's Hospital were reviewed. Six of 16 patients with meconium ileus had preoperative ultrasonograms. All six patients with meconium ileus had multiple loops of bowel filled with very echogenic thick meconium. Four of 22 patients with ileal atresia had preoperative ultrasonograms. These four patients with ileal atresia had dilated loops of bowel filled with fluid and air. None had a dilated bowel filled with thick echogenic contents. Preoperative abdominal ultrasonography is proposed as a simple method for distinguishing between these two disease entities with very different treatment plans.
Insights
Abdominal ultrasonography can differentiate meconium ileus from ileal atresia. Ultrasound shows echogenic meconium in meconium ileus, distinguishing it from the fluid-filled bowel seen in ileal atresia.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Meconium ileus and ileal atresia present similar radiographic findings (microcolon, small bowel obstruction).
- Accurate differentiation is crucial as meconium ileus may be treated non-surgically, while ileal atresia requires immediate surgery.
Purpose of the Study:
- To evaluate the utility of abdominal ultrasonography in distinguishing between meconium ileus and ileal atresia.
Main Methods:
- Retrospective review of preoperative abdominal ultrasonograms from patients diagnosed with meconium ileus or ileal atresia.
- Analysis of imaging findings, specifically bowel contents and distension patterns.
Main Results:
- All six meconium ileus patients exhibited multiple bowel loops filled with echogenic meconium.
- Four ileal atresia patients showed dilated bowel loops containing fluid and air, with no echogenic contents.
Conclusions:
- Preoperative abdominal ultrasonography is a valuable, non-invasive tool for differentiating meconium ileus from ileal atresia.
- Distinct ultrasound findings (echogenic meconium vs. fluid/air) aid in guiding appropriate, timely treatment strategies.