Meconium obstruction in a premature neonate: An etiology that may simulate spontaneous intestinal perforation

A surgeon expects either necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) in preemies with pneumoperitoneum. But there is another cause wherein the operative findings simulate meconium ileus [1]: The terminal ileum and colon are tiny and obstructed by inspissated meconium; The bowel proximal to the obstruction may be diffusely dilated, or there may be aneurysmal (segmental) dilatation, which may be single or multiple; Resection with ileostomy is all that is attempted in these tiny, fragile babies; Surprisingly, when the ileostomy is closed 4-6 weeks later, the bowel appears to be normal, the obstruction has cleared and the caliber disparity has disappeared, which suggests that immaturity was causative of the obstruction and the occasional aneurysmal dilatation.