A 3-day-old term neonate presents with bilious vomiting, abdominal distension, and failure to pass meconium. X-ray shows dilated loops of bowel with a 'ground glass' appearance in the lower abdomen and absence of air-fluid levels. Sweat chloride test is later found to be elevated. What is the most likely diagnosis?

• A Hirschsprung disease
• B Duodenal atresia
• C Jejunal atresia
• D Meconium ileus ✓

Explanation

Meconium ileus is a neonatal intestinal obstruction caused by abnormally thick, tenacious meconium blocking the terminal ileum. It is the earliest clinical manifestation of cystic fibrosis (CF), which is confirmed by an elevated sweat chloride test. The 'ground glass' or 'soap bubble' appearance on X-ray in the right lower quadrant (Neuhauser sign) results from gas mixing with thick meconium, and air-fluid levels are characteristically absent because the meconium is too viscous to layer.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.