ABSTRACT
Non-operative management of meconium ileus depends on dissolution of the inspissated intraluminal meconium in an otherwise patent and uncompromised ileocolon. H. R. Noblett reported the successful use of a hypertonic contrast enema in four neonates with uncomplicated meconium ileus. Multiple indications exist for operative intervention in the management of meconium ileus. One-third to one-half of patients undergoing operation represent cases of simple or uncomplicated meconium ileus who have failed to respond to non-operative treatment with enema solubilising agents. An alternative technique is appendicectomy and appendicostomy, with meconium evacuation or irrigation through this route. Maternal polyhydramnios may be a feature of in utero meconium ileus, occurring in almost 20% of mothers of newborns with meconium ileus and at an even higher frequency when there is complicated meconium ileus. Plain radiography will not differentiate other causes of a distal small-bowel obstruction, including ileal atresia, Hirschsprung's disease or the meconium plug syndrome.
