Meconium Plug (Small Left Colon Syndrome)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
Ganglion cells are present but immature and this causes a functional colonic inertia which leads to a meconium plug forming in the colon, that causes obstruction and a narrowed descending colon. A certain percentage of these patients also have Hirschsprung disease, so they must be followed closely to see if they develop symptoms of chronic constipation and require a rectal biopsy to rule out Hirschsprung Disease.

Pathology:
Present, but functionally immature ganglion cells.

Imaging Findings:
An enema shows a normal sized rectum and small caliber sigmoid and descending colon with a transition zone in colonic caliber occurring at the level of the splenic flexure. The meconium plugs are often outlined by the enema contrast material.The enema is most often curative.

DDX:
Low Bowel Obstruction

• Hirschsprung Disease
• Meconium Ileus
• Meconium Plug
• Ileal Atresia

References:
See References Chapter.

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