Meconium Ileus vs. Ileus of the Newborn, Hirschsprung´s Disease
Left picture: Here, the cause of the intestinal obstruction is a meconium ileus; notice the color of the skin and the nutritional state in comparison with the contralateral patient. Operative findings: The ileum is proximally dilated by thick and viscous meconium (picture in the middle), and distally, the terminal ileum is narrow and contains white globules of secretion (picture at the bottom). Right picture: On account of the clinical presentation and of the plain abdominal x-ray in upright position with severly distended intestinal loops reaching to the site of the rectum, the diagnosis is an ileus caused by a Hirschsprung´s disease. A rectal tube without and with lavage enables drainage of air and of malodorous breast milk stool in the picture at the bottom on the right side.
Left picture: Newborn with a surgical abdomen with missing passage of meconium, impossibility to be fed (gastric tube for drainage of secretions), distended belly (discrepancy between the size of the belly and the chest, and prominent intestinal loops in the midline). What pathology is present here? Right picture: Newborn with an acute abdominal emergency with a very large belly (actually symmetrical protrusion without prominent intestinal loops), respiratory distress (because of which monitorizing is performed), with bilious vomiting following initial feeding and with missing passage of meconium. What are you thinking of?