Meconium Ileus — RACP Paediatrics MCQ

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ModerateNeonatologyMeconium IleusRACP Paediatrics

A newborn presents with bilious vomiting and failure to pass meconium in the first 48 hours. Abdominal X-ray shows distended loops of bowel with no gas in the rectum. A contrast enema shows a microcolon. What is the most likely diagnosis?

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Correct answer: B — Meconium ileus

Meconium ileus presents with bilious vomiting, abdominal distension, and failure to pass meconium. Contrast enema shows a microcolon (unused colon) with inspissated meconium pellets in the terminal ileum. Approximately 90% of neonates with meconium ileus have cystic fibrosis, and sweat testing/genetic testing should be performed. Treatment may involve Gastrografin enema or surgery.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Neonatal Bowel Obstruction