A 3-day-old term neonate has abdominal distension, bilious vomiting, and failure to pass meconium. A contrast enema demonstrates a unused microcolon with filling defects in the terminal ileum, and there is a family history of cystic fibrosis. Sweat chloride testing is pending. The most useful therapeutic intervention at this stage is:

• A Hyperosmolar (Gastrografin) contrast enema ✓
• B Emergency laparotomy with ileostomy
• C Rectal suction biopsy
• D Serial saline enemas and oral rehydration alone

Explanation

Microcolon with inspissated meconium pellets in the terminal ileum in a neonate with suspected cystic fibrosis indicates meconium ileus. B hyperosmolar water-soluble contrast enema is both diagnostic and therapeutic: it draws fluid into the lumen by osmosis and dislodges the pellets, relieving obstruction in a majority of uncomplicated cases. Laparotomy is reserved for perforation or failure of contrast evacuation. Rectal biopsy diagnoses Hirschsprung disease, the main differential.

Reference: Pediatric Surgery, Ashcraft's, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.