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Meconium ileus – CF — RACP Paediatrics MCQ

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ModerateGIMeconium ileus – CFRACP Paediatrics

A term neonate with known cystic fibrosis (diagnosed antenatally) has not passed meconium by 48 hours. Abdominal X-ray shows distended small bowel loops with a ground-glass (soap bubble) appearance in the right lower quadrant and no air-fluid levels. What is the most likely diagnosis?

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Correct answer: D — Meconium ileus

Failure to pass meconium with distended small bowel and a ground-glass/soap-bubble appearance in the right iliac fossa (inspissated meconium mixing with air) is meconium ileus. It occurs in ~15-20% of neonates with CF. Initial management is with gastrografin enema (diagnostic and therapeutic). If this fails, surgical intervention is required.

Reference: RCH Melbourne – 2023 – Neonatal Bowel Obstruction CPG; RACP Paediatric Curriculum – Neonatology/GI