More than constipation: Failure to pass meconium

Case presentation

A 2-day-old patient is referred to the emergency department for failure to pass meconium. He was born at home and had prenatal care, although this was not consistent, as the mother had missed some of her appointments. The delivery was at term (38 weeks gestation), vaginal, and apparently uncomplicated. The infant was vigorous and did not require resuscitation other than standard drying and stimulation. The mother’s serologies were negative. He has been breastfeeding for 10–15 minutes’ total time, approximately every 2–3 hours. He appears to feed well. He has had some small voids.

Physical examination reveals an afebrile, vigorous child. Heart rate is 150 beats per minute, respiratory rate is 30 breaths per minute, and a blood pressure is 75/50 mm Hg. He has an overall normal examination, but there is abdominal fullness. There is no hepatosplenomegaly, apparent tenderness, or discoloration of the abdomen. He has a patent anus and appears to have decreased rectal tone with digital rectal examination.

Imaging considerations