NEONATAL ULTRASONOGRAPHY TO DISTINGUISH BETWEEN MECONIUM ILEUS AND ILEAL ATRESIA

Meconium ileus can be difficult to distinguish from ileal atresia on p lain radiographs and on contrast enema. Both show a microcolon in the face of a small bowel obstruction. The treatment of the two is very di fferent. Meconium ileus obstruction may be relieved medically by contr ast enema; ileal atresia requires prompt surgical intervention. This s tudy was made to determine if abdominal ultrasonography might be helpf ul in distinguishing between these two entities. Abdominal ultrasonogr ams from the past 10 years of all patients with these hive diseases wh o were studied with preoperative ultrasonography at Arkansas Children' s Hospital were reviewed. Six of 16 patients with meconium ileus had p reoperative ultrasonograms. All six patients with meconium ileus had m ultiple loops of bowel filled with very echogenic thick meconium. Four of 22 patients with ileal atresia had preoperative ultrasonograms. Th ese four patients with ileal atresia had dilated loops of bowel filled with fluid and air. None had a dilated bowel filled with thick echoge nic contents. Preoperative abdominal ultrasonography is proposed as a simple method for distinguishing between these two disease entities wi th very different treatment plans. KEY WORDS: Meconium ileus; Ultrason ography; Ileal atresia.