0:01

This was a one day old female who had abdominal distension

0:04

and failure to pass meconium.

0:06

We have an abdominal radiograph with an enteric tube

0:08

with the tip projecting over the leftward aspect

0:10

of the gastric body.

0:12

Um, and then when we draw our line along the, uh, equator

0:16

of this abdomen, we have dilated bowel loops both above

0:20

and below the equator.

0:21

So this is a distal BGAs obstruction pattern.

0:24

So this patient will go on to contrast enema

0:26

as the next step in the workup of, uh,

0:29

of why there is a distal, um,

0:31

distal obstructive BGAs pattern.

0:33

The left lateral acute dispute doesn't add much.

0:35

It just shows that there's no pneumoperitoneum.

0:38

Obviously, we don't see pneumatosis

0:39

or portal venous gas in this infant either.

0:43

So this patient came next to the fluoroscopy suite

0:45

to undergo contrast enema.

0:47

We don't have a scout on this patient

0:49

because that x-ray was immediately preceding this.

0:52

So we use that x-ray as our scout image

0:54

for this contrast enema.

0:55

So we have placed a, a catheter in the rectum.

0:58

We have injected, um,

1:00

or instilled by gravity drip,

1:02

a dilute water soluble contrast.

1:04

Um, here is our lateral rectum filling shot.

1:07

We want our rectum to be larger than our sigmoid ratio, um,

1:11

which maybe you can see better on this,

1:13

uh, later filling image.

1:14

So we have a normal rectal sigmoid ratio

1:17

where the rectum is larger than the caliber

1:19

of the sigmoid colon, but the abnormality here is

1:23

that the rest of the colon is pretty diminutive.

1:26

So, uh, uh, normal rectum, somewhat normal sigmoid,

1:29

but the rest of the descending colon is pretty small in

1:32

caliber until we get to the level of the splenic flex.

1:36

Once we get to the level of the splenic flexure, the caliber

1:38

of the colon is more normal in appearance.

1:41

So this, this appearance of normal caliber rectum

1:44

with diminutive remainder of the rest

1:45

of the descending colon is really classic for

1:49

functional immaturity of the colon

1:50

or small left colon syndrome.

1:53

Um, it's the same diagnosis,

1:54

just two different names for the same thing.

1:57

So the good news is, um,

1:58

this contrast ENA enema is probably not only diagnostic,

2:02

but it's probably therapeutic.

2:04

Um, the water soluble contrast is a little bit hyperosmolar.

2:07

It draws water from the body into the colon to help, um,

2:11

that meconium pass, uh, pass through that distal colon.

2:16

And, and whatever other content is in, is in the,

2:19

uh, is in the colon.

2:21

This is a, a diagnosis that is more common in infants

2:24

of diabetic mothers

2:25

and infants who, uh, the, the mother was treated

2:28

with magnesium prior to, um, delivery.

2:31

And it's usually a self resolving, um, abnormality,

2:36

especially after a contrast enema to help things get moving.

2:39

So no surgical, uh, treatment or other treatment is needed.

2:44

Um, they just, uh, will continue

2:46

to clinically monitor this patient to ensure that the, um,

2:49

stooling becomes normal after this enema.