The tryptic activity and presence of cornified squames in meconium as a diagnostic aid in congenital intestinal obstruction.

With the increasing efficiency of the surgery of the newborn the accurate diagnosis of congenital anomalies of the alimentary tract has become more important. The technical aids to the diagnosis of congenital intestinal obstruction are of three types: (1) radiological examination, taking advantage of the gas in the bowel and occasionally using opaque substances; (2) the examination of vomited and aspirated material for the presence of bile and pancreatic ferments; and (3) examination of meconium. Of these methods radiology is undoubtedly the most widely practised, and few clinicians use other tests. However, it is not an infallible guide as can be seen by the figures from the Children's Hospital in Boston in 1946, when only seven of 23 cases of congenital intestinal atresia were correctly diagnosed by radiology. The radiological appearances in intestinal anomalies are well described by Caffey (1950) and by Ladd and Gross (1941) and are not the concern of this paper. The importance of the examination of vomited material and fluid obtained by gastric suction is obvious. The presence of bile indicates patency of the biliary and gastro-duodenal passages. If duodenal suction is used the findings of tryptic activity in alkaline fluid would suggest an absence of that type of meconium ileus which is usually associated with gross pancreatic change. The naked eye examination of the stools in intestinal atresia is occasionally misleading. When the stool consists of a pale, mucoid thread or small green-centred fragments covered with mucus-like ' rabbit droppings ' there is no confusion (Fig. 1), but not infiequently infants with atresia situated fairly high up in the intestinal tract pass meconium which is described by experienced paediatricians as being normal. It is these apparently normal stools which cause confusion in diagnosis and delay in treatment. This is doubly unfortunate since these high obstructions are most amenable to surgical treatment. In such cases more detailed examination of the meconium can be of assistance. The test that is most widely known and used in