Abdominal and GI imaging: meconium ileus management: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Abdominal and GI imaging: meconium ileus management

Sample item

A newborn with cystic fibrosis fails to pass meconium. The abdominal film shows dilated loops of variable calibre without air-fluid levels and a bubbly ground-glass density in the right iliac fossa. There is no free air or volvulus. What is the initial treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Hyperosmolar water-soluble contrast enema

Tenacious meconium is retained in the terminal ileum. Under fluoroscopy, a hyperosmolar water-soluble enema draws fluid into the bowel and loosens the plugs. Surgery is reserved for failure or complications such as perforation, atresia or volvulus.

Option by option

  • A. Hyperosmolar water-soluble contrast enema (correct)

    Correct. A water-soluble enema is both diagnostic and therapeutic in uncomplicated meconium ileus.

  • B. Oral barium follow-through

    Oral barium would add to the obstruction and does not clear meconium.

  • C. Barium enema with high pressure

    Barium is not used, because it can inspissate and cause peritonitis if the bowel perforates.

  • D. Immediate laparotomy and ileostomy

    Surgery is for complicated cases, whereas uncomplicated ileus is treated non-operatively first.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Hyperosmolar water-soluble contrast enema. Tenacious meconium is retained in the terminal ileum.

Why is "Oral barium follow-through" not the answer?

Oral barium would add to the obstruction and does not clear meconium.

Why is "Barium enema with high pressure" not the answer?

Barium is not used, because it can inspissate and cause peritonitis if the bowel perforates.

Why is "Immediate laparotomy and ileostomy" not the answer?

Surgery is for complicated cases, whereas uncomplicated ileus is treated non-operatively first.

What concept does this question test?

It tests Abdominal and GI imaging: meconium ileus management in Radiology. Under fluoroscopy, a hyperosmolar water-soluble enema draws fluid into the bowel and loosens the plugs. Surgery is reserved for failure or complications such as perforation, atresia or volvulus.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdominal and GI imaging: meconium ileus management?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.