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Functional Intestinal Obstruction of the Premature Newborn

Functional intestinal obstruction of the premature newborn is also called "meconium ileus-like syndrome" because, as in the case of meconium ileus, an obstruction exists at the distal ileum and caecum but meconium has passed. The obstruction is caused not by meconium but by stools.

As in meconium ileus, there is a motility disturbance of the bowel. However, it can also be related to absorption problems if inadequate feeding formula is used (so-called milk curd syndrome) (Devos and Meradji 2003). Clinical symptoms are similar to meconium plug syndrome or meconium ileus and are those of obstruction, such as progressive vomiting, progressive abdominal distension and failure to pass stools. Sometimes a mass can be felt in the (right) side of the abdomen.

Plain film shows most frequently a dilated small bowel with only a few or even no fluid levels and an absence of air in the rectum. Because of air-trapping in stools, a mottled appearance can be seen in the right side of the abdomen (Fig. 5.13a,b). US will show dilated small bowel loops (ileum) fully filled with huge hypoechogenic masses (Fig. 5.13c). A contrast enema with nonionic media shows fecal impaction in upper colonic segment or higher ileum. This pro-

Free Air Lateral Decubitus Film

Fig. 5.12. a Pneumoperitoneum with a "triangle sign" on the cross-table lateral film. b Left lateral decubitus image (presented as if an AP view). Free air is located in the 'highest point': between abdominal wall and liver

Fig. 5.12. a Pneumoperitoneum with a "triangle sign" on the cross-table lateral film. b Left lateral decubitus image (presented as if an AP view). Free air is located in the 'highest point': between abdominal wall and liver a b

Fig. 5.13. a A premature infant with intestinal dysfunction, so-called meconium ileus-like syndrome. The supine abdominal film shows dilated intestinal loops because of fecal impaction in ileum. b Cross-table radiograph. Meconium-like ileus with dilated intestinal loops without fluid levels. The whole colonic tract and rectum are airless. c Ultrasound of the right lower quadrant of abdomen demonstrates the impacted and inspissated stool in the ileum

Fig. 5.13. a A premature infant with intestinal dysfunction, so-called meconium ileus-like syndrome. The supine abdominal film shows dilated intestinal loops because of fecal impaction in ileum. b Cross-table radiograph. Meconium-like ileus with dilated intestinal loops without fluid levels. The whole colonic tract and rectum are airless. c Ultrasound of the right lower quadrant of abdomen demonstrates the impacted and inspissated stool in the ileum b a cedure may have a therapeutic effect (Carty et al. 2005; Parker 2003; Devos and Meradji 2003).

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Constipation Prescription

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