Ongoing extreme constipation (obstipation) and abdominal pain.
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First image is a spot image from initial fluoroscopy of large bowel barium demonstrating narrowing of rectum and proximal pooling of contrast.
Repeat radiograph 24 hours later shows retention of contrast.
Hirschsprung disease is typically diagnosed shortly after birth.
In rare cases, it may develop gradually, presenting with non-specific symptoms such as constipation and abdominal pain, as in this case.
Suction rectal biopsy confirmed a lack of ganglionic nerve cells consistent with Hirschsprung disease.