A two days old male baby weighing 2.5 kg presented with abdominal distension, failure to pass meconium and biliary emesis since birth. The baby was born by spontaneous vaginal delivery at home. According to the mother the patient was born with a distended abdomen and passed white pellets per rectally. The abdominal distension gradually worsened with bilious vomiting after every attempt at feeding. General physical examination revealed a lethargic and ill looking baby with obvious respiratory distress and abdominal distension. He was febrile with temperature of 100 °F; respiratory rate 45/min, and pulse 150/min. Bowel loops were visible. A per-rectal examination revealed meconium beads. A preoperative diagnosis of neonatal intestinal obstruction secondary to meconium ileus, with a differential of distal intestinal atresia, was made.
The newborn was resuscitated with intravenous infusion. A nasogastric tube was passed and gastric aspiration done. The neonate was given injection Vit. K and intravenous antibiotics started. X-ray abdomen showed dilated bowel loops. Contrast x-rays with gastrografin enema delineated a small caliber colon with filling defects as of meconium beads (Fig. ). As condition of the baby did not improve an exploratory laparotomy was performed. At laparotomy volvulus of distended small bowel found. The colour of the involved segment was dark and appeared congested (Fig. ). The volvulus was corrected by untwisting the mesentery. The involved gut was hugely distended due to the presence of thick tenacious meconium. The thick meconium was concentrated in distal small bowel whereas the colon was packed with small beads. An enterotomy was made at the most distended portion (distal ileum) and irrigated with diluted gastrografin. Gentle milking was then performed to remove the meconium. The large gut also washed in the similar way. Bishop Koop chimney was made after resecting a small portion of small bowel which was of doubtful viability.
Figure 1: X-ray abdomen erect with gastrografin enema, showing small caliber of colon and filling defects
Figure 2: Operative view of twisted small bowel. The discolored and hugely distended bowel is obvious
The postoperative recovery was uneventful. NG tube was removed on 4th post-op day with oral feed on following day and discharged on 7th postoperative day. The patient has an uneventful follow up after Bishop-Koop stoma closure (at the age of 6 months).