Clinical Presentation

A newborn with failure to pass meconium.

Contrast enema demonstrates a small, unused colon. Contrast refluxed into the terminal ileum outlines multiple small filling defects (arrow). There are dilated loops of small bowel more proximally.

Differential Diagnosis

• Meconium ileus: These findings are typical of meconium ileus.

• Meconium plug syndrome: Meconium plugs should be found throughout the colon, not solely in the terminal ileum. Usually, there is a transition point at the splenic flexure with dilated colon more proximally. Plugs may be passed during administration of the enema.

• Ileal atresia: