1 year 11 month boy presented with
progressive history of minimal bowel opening for the past 1 year with on and
off abdominal pain. Still able to pass flatus and minimal amount of feces.
Child otherwise active and tolerating orally.
On examination, child is active,
well and not toxic looking. vital signs are normal. Abdomen is distended but soft.
Bowel sound present. Per rectal reveal impacted stool. No blood or mucous
present
Abdominal X Ray shows dilated large
bowel (proximal region) with no air in the rectum region. Fecal impaction was
seen at the region of ascending colon. No air fluid level is seen.
Based on the history, physical
examination and abdominal X ray, surgical team was consulted and the impression
is TRO Hirschsprung's disease.
Hirschsprung's disease is due to
absence of Auerbach (myenteric) and Meissner (sub mucosal ganglion cells)
plexus of the large colon and may affect variable length of large colon. This
will cause reduce peristaltic bowel movement in the affected bowel segment.
This will usually cause mega colon of the bowel proximal to the lesion and
collapsed bowel distal to the lesion.
Early presentation are observed in
newborns and infants like fail to pass meconium shortly after birth, fail to
pass first stool within 24-48 hours of life, jaundice, poor feeding, poor
weight gain, vomiting, watery diarrhea and infrequent but explosive stool
Older child may presented with
gradually worsening of constipation, fecal impaction, distended abdomen,
malnutrition, or failure to thrive.
Child is best to be admitted to exclude
other diagnosis especially acute abdomen. Bowel preparation should be done and
rectal wash put can be performed.
Rectal biopsy is a diagnostic test
and once confirmed positive of Hirschsprung's disease, a laparotomy with bowel
resection of aganglionic region with end to end anastomosis or colostomy can be
performed.
No comments:
Post a Comment