Differential diagnosis of complications of meconium

Approach to the differential diagnosis of complications of meconium:

  • Meconium aspiration syndrome should be assumed to be the cause of respiratory distress in the term / post-term infant with coarse interstitial infiltrates and hyperexpansion
  • Meconium plug syndrome is associated with a small caliber left colon on enema
  • Meconium obstruction of prematurity is only seen in extreme prematurity, does not have a microcolon, multiple plugs of meconium are seen in colon and small bowel
  • Complicated meconium ileus is usually associated with extensive fine calcifications on AXR
  • Uncomplicated meconium ileus is associated with a microcolon on enema
  • Distal intestinal obstruction syndrome can be assumed when a patient with cystic fibrosis presents with abdominal pain and stool in their distal small bowel