Enema for reduction of meconium ileus

  • Patient preparation: patient needs to be well hydrated before and after the procedure as the high osmolar water soluble contrast used causes fluid to flow into the bowel lumen to facilitate the passage of meconium
  • Contrast used: high osmolar water soluble, dilute contrast using 1 part contrast : 2 parts sodium chloride if < 1 year old or 2 parts tap water if > 1 year old
  • Technique: red rubber catheter in a higher than usual position, tape tip in securely, use gravity or gentle hand injection to instill contrast, start contrast with patient in a lateral position, turn the patient then to supine and to prone in order to opacify the entire colon with contrast and reflux the terminal ileum, may need to do several cycles of colon filling and evacuating
  • Images to obtain: AP overhead
  • Looking for: need to reflux contrast into the dilated loops of ileum above the inspissated meconium in the terminal ileum in order to have the best chance to clean out the meconium
  • Post procedure tasks: enema may have to be repeated several times over several days to completely relieve the obstruction