Investigations, management and outcome of neonates presenting with distal intestinal obstruction: challenging the need for contrast enemas

Topic overview

Key takeaways

• Colonic irrigation should be first-line therapy for neonatal distal bowel obstruction, avoiding contrast enema in most cases.
• All neonates with distal obstruction require suction rectal biopsy to rule out Hirschsprung disease unless alternative diagnosis is clear.
• Meconium plug passage warrants cystic fibrosis testing, as CF was found in 3/19 meconium plug cases.
• Hirschsprung disease was the most common final diagnosis (54%), followed by meconium plug syndrome and intestinal atresia.
• Median neonatal unit stay was 11 days, reflecting the resource-intensive multimodal evaluation required for these patients.

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