C. Pion Kao, MD

This 17-year-old presented with a 1-month history of weight loss, increased appetite, mild insomnia, hand tremor, palpitations, sweating, heat intolerance, and quick loss of temper. The number of daily bowel movements had increased from 1 to 2. There was no family history of thyroid disorders.

The extent of mucosal or transmural intestinal necrosis varies. Pneumatosis progresses from the submucosa through the muscular layer to the subserosa. The distal ileum and proximal colon are most frequently involved.

This condition, which accounts forabout 30% of cases of intestinal obstructionamong neonates, is characterizedby the inspissation of thick,tenacious meconium in the bowel.The most common cause is cystic fibrosis;approximately 6% to 20% of infantswith cystic fibrosis have meconiumileus. Hyperviscous mucus secretedby abnormal intestinal glands,an abnormal concentrating processin the proximal small intestine, and adeficiency of pancreatic enzymeshave been implicated in the pathogenesis.The histologic hallmark is distention of the gobletcells in the intestinal mucosa.