Meconium Plug Syndrome (Differential Diagnosis)

2-day-old girl with vomiting and missing evacuation of meconium. The contrast enema shows a columnar defect reaching from the rectum to the transition of the sigmoid to the colon descendens !Łobst_18_pŁ!. Following this examination the evacuation of dark-green and sticky meconium with a glassy appearing mucous at the end of the plug occurred. Afterwards there was regular rectal transit. The evacuation of such a plug may also occur after a rectal examination or spontaneously as shown in the additional picture obst_18b_n.jpg. The plug consists in its upper and smaller portion of grey and glassy mucus and in its lower main part of dark-green to black and sticky meconium. Underneath the buttock fluid meconium may be seen which has been evacuated after the passage of the plug. (I owe this picture to R. Stern, Department of Surgical Pediatrics (Prof. Z. Zachariou), University of CH-Bern). It is a special type of delayed evacuation of meconium, called meconium plug syndrome. It may be a sign of Hirschsprung's disease, with further clinical observation being necessary.