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and abdominal scarring Infants with meconium peritonitis and signs of intestinal obstruction often require exploratory laparotomy Meconium plug syndrome is thought to occur because of colonic hypomotility, and is commonly seen in preterm infants and infants of diabetic mothers Similar to meconium ileus, neonates typically present with failure to pass meconium within the first few days of life and progressive abdominal distention Contrast enema is often diagnostic and therapeutic, with much higher success rate of fully evacuating the meconium than with meconium ileus The need for surgical evacuation of the meconium is uncommon; however, meconium plug syndrome may be associated with Hirschsprung disease and cystic fibrosis, so patients should be evaluated for both Hirschsprung Disease Hirschsprung disease results from an aganglionic segment of the colon that results in a distal intestinal obstruction Up to 90% of infants present in the neonatal period with abdominal distention, emesis, and failure to pass meconium The abdomen is often soft, and a digital rectal examination may result in explosive stool Contrast enema can be diagnostic in up to 80% of cases when a transition zone is identified Definitive diagnosis is achieved by identification of complete aganglionosis on a biopsied specimen Eight percent of cases will have total colonic Hirschsprung Hirschsprung-associated enterocolitis occurs in up to 10% of cases but can be life threatening if unrecognized Treatment for enterocolitis requires emergent decompression of the rectum and broad-spectrum antibiotics Definitive treatment of Hirschsprung disease requires surgical resection of the aganglionic segment Anorectal Malformations Anorectal malformations leading to intestinal obstructions include the imperforate anus Most patients have associated fistulas that result in some meconium passage that can delay diagnosis In males, the fistulas can occur between the rectum and urinary tract, and in females between the rectum and perineum, vestibule, or bladder Clinicians should examine the perineum closely and look for associated malformations of the sacrum, spine, spinal cord, and genitourinary tract Treatment requires surgical correction of the malformation, which may include primary repair or colostomy, depending on the presence of associated anomalies Adhesions
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