Seyed Ali Alamdaran - MD, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ahmad Mohammadipour - MD, Department of Pediatric Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali Azadmand - MD, Department of Pediatric Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Reza Shojaeian - MD, Department of Pediatric Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Halime sadat Arabi Moghadam - MD, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Dear Editor-in-Chief, The inspissated meconium pellets are a cause or effect of ileocolic obstructions. The present study aimed at explaining our experience of ultrasound-based approach for differentiation and treatment of the inspissated meconium pellets. This study was conducted at Mashhad University of Medical Sciences, Mashhad, Iran, from ۲۰۱۷-۲۰۲۰. Twenty-four neonates (less than ۸ days) with inspissated meconium pellets were examined using ultrasound. Moreover, in cases with non-complicated inspissated meconium pellets, ultrasound-guided contrast enema was performed for confirmation of the diagnosis or probable treatment. In ultrasound, the inspissated meconium pellets were observed as uniform hypo- to hyper-echoic tubular or beaded intra-luminal material in ileocolic loops or recto-sigmoid area. These pellets were in five states: simple meconium ileus, localized or generalized meconium, small bowel, meconium plug syndrome, and Hirschsprung's disease. During contrast enema in non-complicated meconium ileus, moving and floating of inspissated meconium pellets was observed during ultrasound scanning, while this issue was not observed in small bowel atresia. The success rates of the hypertonic contrast enema in patients with simple meconium ileus were ۸۰%. The inspissated meconium pellets have an ultrasound appearance. They are mainly observed in patients with simple and complicated meconium obstructions and bowel atresia. Except in complicated meconium obstructions, the ultrasound-guided contrast enema was performed for their differentiation and probable treatment.

Meconium ileus, Treatment, Ultrasound