A term female infant of a diabetic mother is transferred to you on the 2nd day of life for bilious emesis and failure to pass meconium. Vital signs are normal. The abdomen is distended but soft and non-tender. Rectal exam results in the passage of a small amount of meconium. Plain films and a water-soluble contrast enema are shown. How would you manage this patient?

 

Mostly hypoplastic left colon syndrome

contrast enema may evacuate meconium if not repeat water-soluble contrast enema

Small lt colon syndrome for rectal wash with N-acetylcystine

if no improvement we have to take rectal biopsy to exclude HSD

This is mostly small left colon syndrome, usually presented in neonates with diabetic mother, mostly treated with gasrografin enema or N Acetyl cystine washout, but Hirschsprung’s Disease should be excluded.

Actually first I have think about Hirschsprung's disease but the mother is diabetic and this raise the suspecion of small left colon syndrome. The contrast enema is diagnostic and can be therapeutic. NGT, bowel rest and iv fluids. it's a transient obstruction. Hirschsprung's disease should be excluded by rectal biopsy.​

Edited January 2, 20242 yr by Amal Adam

Small left colony syndrome.Natural course is resolution of disease with time.water soluble contrast enema will both be diagnostic as well as therapeutic

https://www.dropbox.com/scl/fi/0yxvga6oc1phbxvsg32mh/CBCLIPS-Episode-46-1080p.mp4?rlkey=774nsh74kja5u1to05smf5zp1&dl=0