Meconium Ileus

What is meconium ileus?

Meconium ileus (pronounced meh-COE-nee-um ILL-ee-us) means that a baby’s first stool (feces), called meconium, is blocking the last part of the baby’s small intestine (ileum). This can happen when the meconium is thicker and stickier than normal.

Above the blockage, the small intestine becomes enlarged as it fills with everything the baby swallows. Loops of small intestine may push out (distend) the baby’s belly (abdomen). Below the blockage, the large intestine (colon) is smaller than normal. It may be empty, or it may hold small pellets of dried meconium or plugs of mucus from the lining of the intestine.

In most cases, doctors suspect meconium ileus based on signs and symptoms in the first few hours or days after birth.

Meconium ileus in children

Almost all babies with meconium ileus have cystic fibrosis (CF). CF makes certain fluids and mucus in the body thicker than normal. This increases the chance that meconium will get stuck in the ileum. About 1 in 5 babies with CF is born with meconium ileus.

Some babies with meconium ileus have other problems with their intestines, like a hole in the intestine (perforation).

Some babies have a similar blockage in their colon (large intestine) called a meconium plug. A meconium plug is different from meconium ileus. A meconium plug may happen in babies who have small left colon syndrome. This means the last part of their colon is smaller than normal. Small left colon syndrome happens more often in babies whose mothers have diabetes or gestational diabetes (diabetes that happens during pregnancy). Some babies with a meconium plug turn out to have Hirschsprung disease.

The blockage of meconium ileus or meconium plug can be washed out with an enema. If the baby’s intestine is smaller than normal at birth, it grows to normal size after the blockage is removed.

Meconium Ileus at Seattle Children’s

We have treated many babies with meconium ileus at Seattle Children’s.

Sometimes doctors can treat meconium ileus without surgery, but most babies will need surgery. Our surgeons are experienced at selecting the best way to treat each baby and at doing the surgeries children need to clear the blockage in their intestine.

If doctors find a blocked intestine on an ultrasound before your baby is born, the team from our Fetal Care and Treatment Center can monitor your baby’s condition and plan for the care your baby may need after birth.

  • Using minimally invasive procedures when possible

    We do more minimally invasive procedures on children for a broader range of conditions than any hospital in the region. After this type of surgery, your child is likely to heal faster with less pain and go home from the hospital sooner.

    Children react to illness, injury, pain and medication differently than adults. They require – and deserve – care designed specifically for them. Our pediatric experts understand how treatments today affect growing bodies in the future and are specially trained to meet the needs of children and teens.

    We provide the right care, at the right time. We are committed to avoiding unnecessary diagnostic tests, radiation and surgery. Radiation doses at Seattle Children’s are consistently lower than the guidelines recommended by the American College of Radiology.

    Seattle Children’s is 1 of just 5 hospitals nationwide whose commitment to preventing and relieving kids’ pain has been recognized by ChildKind International.

  • The experts you need are here

    When it comes to your child’s health, experience matters. Our surgical teams have the skills to do it right the first time, to handle the unexpected and to care for children with the rarest conditions. We also have experience dealing with other problems that may look like meconium ileus, such as meconium plug and small left colon syndrome.

    More cases mean greater surgical expertise and a sharper ability to determine if surgery is even necessary. All that adds up to better outcomes.

  • Support for your whole family

    When you come to Seattle Children’s, you have a team of people to care for your child before, during and after surgery. Along with your child’s surgeon, you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child’s health needs and help your family through this experience.

    We work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Learn about our services for patients and families.

Symptoms of Meconium Ileus

Babies with meconium ileus may have these symptoms: 

  • No passing of the first stool (meconium)
  • Green vomit (also called bilious because it contains bile, a liquid made in the liver to help digest fats)
  • Swollen belly (abdomen), maybe soon after birth

 Babies with more complex problems – such as a hole in the intestine (perforation) – may have more serious symptoms, like these: 

  • Very swollen, painful, red (inflamed) belly
  • Breathing problems because pressure from the belly keeps the lungs from filling with air

Diagnosing Meconium Ileus

In some cases, a prenatal ultrasound shows that a baby’s intestine may be blocked. If your doctor suspects your baby’s intestine is blocked before birth, the doctor will refer you to a hospital where a medical team can: 

  • Monitor your baby’s condition. For instance, you may need monthly ultrasounds. The team will watch for signs of any problems.
  • Prepare for birth. The team will put a plan in place to manage your baby’s condition after delivery, if needed. 

In most cases, doctors suspect meconium ileus based on signs and symptoms in the first few hours or days after birth. The doctor at Seattle Children’s will ask for a detailed history of your baby’s illness and speak to the doctor who sent your baby here. The doctor at Seattle Children’s will do a thorough exam. By pressing on your baby’s belly, the doctor may be able to feel a loop of small intestine filled with meconium.

Your baby will need X-rays of their belly. X-rays may show enlarged loops of small intestine. Inside the intestine the doctor may see what looks like soap bubbles. These appear when air mixes with meconium.

Your baby will also need to have a lower GI (PDF) (gastrointestinal) series (contrast enema). The test is done using X-rays and a contrast agent. The contrast is put into your baby’s rectum and can be seen on X-rays as it travels through your baby’s large intestine (colon). The X-ray may show that the colon is smaller than normal (microcolon) and there’s a blockage near the end of the small intestine.

If your baby has meconium ileus, your doctor will want to test for cystic fibrosis.

Treating Meconium Ileus

Babies with meconium ileus need to be seen by a surgeon. The surgeon will check for signs of more complex problems. Surgeons can sometimes clear meconium ileus with an enema. Many babies need a surgery to clear the blockage. Those with more complex problems – like a hole in the intestine (perforation) – will need surgery to get the meconium out and to fix the other intestinal problems.

  • Enemas for meconium ileus

    If your baby has only meconium ileus and not a more complex problem, the surgeon will first try to wash out the blockage with an enema guided by X-rays. 

    • In this procedure, a radiologist will place a tube (catheter) in your baby’s rectum.
    • X-ray dye (dilute contrast) will slowly be put through this tube into your baby’s large intestine (colon).
    • The radiologist may also use warm saline. This may be enough to clear the blockage. 

    If the entire blockage does not wash out the first time, the surgeon and radiologist may perform enemas again over the next 1 to 2 days, depending on how your baby is doing.

  • If enemas do not work

    If enemas do not work, your baby will need surgery to remove the blockage. At the time of surgery, we give your baby medicine to make them sleep without pain (general anesthesia).

    The surgeon makes a cut (incision) near the belly button. There are many ways to take care of meconium ileus. Your surgeon will decide which method is best for your baby while doing the surgery. The surgeon may be able to wash out the meconium. But some babies will need to have a segment of their intestine removed (resection) or to have an ostomy (pronounced OST-uh-mee).

Surgery for Complicated Meconium Ileus

The surgeon may advise going straight to surgery and not trying an enema first if your baby has a more complex problem, such as perforation. The goals of surgery are to remove the meconium and keep as much healthy intestine as possible.

Your surgeon will recommend a treatment based on your baby’s problem. The surgeon will explain the procedure your baby is likely to need. Sometimes the surgeon does not know which procedure is needed until they start the surgery and check your baby’s intestine.

  • Resection

    The surgeon removes the segment of intestine that is blocked and any segment that was damaged by the blockage. (Usually when the intestine is perforated, the surgeon must remove that segment.)

    If the rest of the intestine is healthy enough, the surgeon sews the 2 open ends of the intestine back together (primary anastomosis, pronounced an-as-toe-MOE-sis) and closes the incisions. In many cases, the baby needs an ostomy instead.

  • Ostomy

    The surgeon brings the 2 open ends of the intestine to the surface of the baby’s belly and attaches them to openings (stoma) made in the wall of the belly. Sometimes only 1 ostomy is needed. In this case, the surgeon attaches 1 of the open ends to the side of the other open end. Then the surgeon brings just the remaining open end to the surface of the belly.

    After surgery, the surgeon may try to soften and wash out the blockage with liquid. This depends on how much meconium had to be left in the intestine. Liquid can be put through a tube that passes through your baby’s nose to their stomach (NG tube) or through a tube inserted in your baby’s rectum or ostomy. The surgeon may use medicine called acetylcysteine to help soften and move the meconium.

    A bag can be attached to the ostomy to collect waste from the intestine. If your child needs an ostomy, we will teach you how to care for the stoma.

    After the blockage is cleared, the surgeon performs another surgery weeks or months later to close the ostomy and to sew the ends of the intestine together. The baby is usually able to go home with the ostomy before the second surgery.

  • After surgery for meconium ileus

    After surgery, your baby will stay in our Level IV Neonatal Intensive Care Unit (NICU), where they get the high level of care they need. Seattle Children’s is the first hospital in Washington to have a Level IV NICU. When they’re ready, they move to a regular hospital room and, eventually, home.

    The length of hospital stay varies, but is usually at least a few weeks and often longer. The time frame depends mostly on how long it takes your baby to start eating again and gaining enough weight.

    After surgery, your baby will need feedings through a tube that goes into a large vein (central line). When their intestines start to work, most babies need an NG tube or OG tube. Some will be able to eat by mouth instead of having an NG or OG tube. Your doctor will talk with you about the feeding method that is best for your baby.

    We will give your baby pain medicine to make them comfortable.

    The surgeon will stay closely involved with your baby’s care while they are in the hospital. When your baby goes home, the surgeon will schedule a follow-up visit. At the follow-up visit, the surgeon will make sure that the incision is healing and your baby is gaining weight and growing as they should.

    If your baby has cystic fibrosis, lung doctors (pulmonologists) who treat this disease will be a part of your baby’s care and will provide long-term follow-up for many years.

Contact Us

Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information.

To make an appointment, you can call us directly or ask your child’s primary care provider to refer you. We encourage you to coordinate with your primary care provider when coming to Seattle Children’s.

We have clinics in Bellevue, Everett, Federal Way, Seattle and Tri-Cities.

Providers, see how to refer a patient.