The inspissated meconium pellets; another indication for ultrasound based approach to bowel obstruction in newborn.

Purpose: The inspissated meconium pellets are a cause or effect of ileocolic obstructions. The aim of this study was to explain our experience of ultrasound-based approach for differentiation and treatment of the inspissated meconium pellets. Methods and material: This study was performed at Mashhad University of Medical Sciences from 2017-2020.Twenty for neonates (less than 8 days) with with inspissated meconium pellets were examinated by ultrasound and in cases withthe signs of non-complicated inspissated meconium pellets, ultrasound guided contrast enema were performed for confirmation of diagnosis or probably treatment. Result: In ultrasound, the inspissated meconium pellets were seen as uniform hypo-echoic until hyper-echoic tubular or beaded intra-luminal material in ileocolic loops or rectosigmoid area. These pellets were seen in five states: simple meconium ileus, localized or generalized meconium, small bowel, Meconium plug syndrome and Hirschsprung's disease. During contrast enema in non-complicated Meconium  ileus, moving and floating of inspissated meconium pellets was observed during ultrasound scaning, but in small bowel atresia, we didn't observe this finding. The success rates of the hypertonic contrast enema in patients with simple meconium ileus were 80%. Conclusion: The inspissated meconium pellets have a characteristic ultrasound appearance. They are mainly seen in patients with the simple and complicated meconium obstructions and bowel atresia. Except in Complicated meconium obstructions, ultrasound guided contrast enema performed for their differentiation and probably treatment. The success rates of the hypertonic contrast enema in patients with simple meconium ileus were 80%.