Diminishing role of contrast enema in simple meconium ileus Daniel R. Copeland a,b , Shawn D. St. Peter c , Susan W. Sharp c , Saleem Islam d , Alex Cuenca d , Joshua S. Tolleson b , Melvin S. Dassinger a , Danny C. Little a , Richard J. Jackson a , Evan R. Kokoska a , Samuel D. Smith a, ⁎ a Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA b University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA c Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA d Department of Surgery, University of Florida, Gainesville, FL 32610, USA Received 6 February 2009; revised 28 May 2009; accepted 1 June 2009 Key words: Cystic fibrosis; Meconium ileus; Enema; Diatrizoate meglumine Abstract Purpose: Contrast enema is the initial study of choice for simple meconium ileus to confirm diagnosis and to relieve obstruction. Despite favorable historically published results, our clinical impression suggests decreased effectiveness of the contrast enema resulting in more surgical interventions in contemporary practice. Methods: A retrospective multiinstitutional review for a 12-year period was conducted for neonates diagnosed with meconium ileus by contrast enema. The neonates were divided into 2 groups—historic group (HG = before 2002) and contemporary group (CG = after 2002). T test was used for comparison of continuous variables and χ 2 for categorical data. Results: Thirty-seven total patients were identified (21 females and 16 males). Obstruction was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the CG group was 5.5% (1/18) compared to 39% (7/18) in HG. Conclusions: In this review, success of contrast enema for relief of meconium ileus has significantly decreased over time. These findings may be because of reluctance to repeat enemas, change in radiologist experience, or use of contrast agent. As a result, higher rates of operative intervention are now observed. In stable patients, surgeons should recommend repeat enemas before exploration. © 2009 Elsevier Inc. All rights reserved. Cystic fibrosis is the most common inherited defect affecting the white population, occurring in approximately 1:3500 live births [1]. The meconium is highly viscid in these patients resulting in intraluminal obstruction of the small bowel in 6% to 20% of cases [2-5]. Complications of this obstruction can include intestinal atresia, free perforation, or volvulus requiring prompt surgical attention. Simple meconium ileus (MI) is first managed nonopera- tively with contrast enema to establish a diagnosis and attempt to clear the obstruction. Success is reported in ⁎ Corresponding author. Tel.: +1 501 364 2942 (Office); fax: +1 501 364 5399. E-mail address: SmithSamueID@uams.edu (S.D. Smith). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2009.06.005 Journal of Pediatric Surgery (2009) 44, 2130–2132