Investigation

The diagnosis is suggested clinically, but is aided by an abdominal radiograph, which may reveal a mottled appearance due to lipid droplets within the meconium. This has been referred to as a 'soap bubble' appearance, and is usually in the right iliac fossa. The bowel distal to the obstruction is usually small, despite being colon.

After the diagnosis has been made, the infant should also have a sweat test to confirm or rule out the diagnosis of cystic fibrosis. Since MI in CF patients usually correlates with pancreatic insufficiency, a faecal elastase test should also be performed to evaluate pancreatic function. (2)

Reference

1. Sathe M, Houwen R. Meconium ileus in Cystic Fibrosis. J Cyst Fibros. 2017 Nov;16 Suppl 2:S32-S39
2. Carlyle BE, Borowitz DS, Glick PL. A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon. J Pediatr Surg. 2012 Apr;47(4):772-81