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Meconium ileus was first described by Landsteiner in 1905 (4), and many reports have since appeared correlating the condition with pancreatic insufficiency (2, 3). Neuhauser (5) found roentgen evidence of air bubbles mixed with thick meconium in 40 per cent of his cases and considered this finding characteristic of meconium ileus. Bruwer and Hodgson (1), however, reported a similar observation in imperforate anus. Recently White (6) described 6 cases of uncomplicated meconium ileus in which no air-fluid levels could be demonstrated on the upright film. He attributed the appearance of fluid levels in previously reported cases of meconium ileus to such complications as gangrene, peritonitis, and volvulus, or to gastric lavage, and believed that their absence could be regarded as a new sign of the disease. In the case to be reported here, air-fluid levels were demonstrable, though no complications were present. case report A white female infant weighing 4,040 gm. was born on Sept. 8, 1956. The pregnancy appeared to have been normal and delivery was uncomplicated. Examination immediately after birth revealed no unusual features. On the evening of the first day of life, mild abdominal distention was observed. This progressed and was associated with vomiting and increased distention within twenty-four hours after delivery. A supine film (Fig.1) showed multiple dilated loops of bowel, many of which represented small intestine. It was difficult to tell whether or not there was any gas in the colon. The bubble appearance described by Neuhauser was observed, involving several loops of bowel in the mid-abdomen. Figure 2 shows the upright film. A half-dozen or more air-fluid levels are apparent. A barium enema study was attempted, and the rectum and part of the lower sigmoid were fairly well demonstrated. From the films, it was concluded that there was no evidence of low obstruction or of a partially imperforate anus. After this first attempt, two films, an anteroposterior and a lateral, were made with the patient held in such a way that the head was low and the feet were high. These films are reproduced as Figures 3 and 4. Again multiple air-fluid levels were demonstrated. On a repetition of the barium enema, the barium was seen to pass to the mid-transverse colon (Fig.5). It was concluded that the patient had a small bowel obstruction. Exploratory laparotomy was undertaken at the age of thirty-four hours. No free fluid was encountered in the peritoneal cavity. The small bowel was dilated to a maximal diameter of 4 cm., extending from a point about 15 cm. distal to the ligament of Treitz to within 10 cm. of the ileocolic valve. The affected segment presented a dusky appearance and a putty-like consistency. An enterostomy was created some 20 cm. above the ileocolic valve, disclosing a stringy, plastic, and tenacious meconium.