In cases of uncomplicated meconium ileus, the infant usually presents shortly after birth with symptoms of lower gastrointestinal obstruction including abdominal distension and vomiting which may or may not be bile stained. The rectum may be empty and narrow and the infant does not pass meconium. If meconium ileus is complicated by volvulus, intestinal ischemia or perforation, the infant can be systemically unwell with acidosis, undergo hypovolemic shock and may require ventilatory support. Abdominal X-ray showing dilated intestinal loops and occasionally abundance of meconium in the right lower quadrant are supportive of the diagnosis, as is a gastrograffin contrast enema revealing a small collapsed colon (microcolon) and often inspissated pellets of meconium in the right lower quadrant.
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