Presentation
Poor feeding, vomiting and abdominal distension.
Patient Data
Multiple air-filled bowel loops which are dilated. Loss of normal polyglonal shape of the bowel loops. Absence of rectal gas. No pneumoperitoneum.
Cardiomegaly with bilateral interstitial lung opacities.
Impression: Low/distal bowel obstruction.
Abdominal radiograph at 2 months of life after recurrent vomiting and feeding intolerance
Persistent dilated air-filled bowel loops. No rectal gas.
Bilateral pleural effusion with background of chronic lung fibrosis/bronchopulmonary dysplasia.
Proceeded with lower gastrointestinal study.
A transition zone is at the junction between transverse colon and descending colon/splenic flexure. Reduced caliber of descending colon, sigmoid colon and rectum (distal to the transition zone) (the rectum is smaller than the transverse colon) with a saw-tooth appearance to the wall.
After the lower gastrointestinal study, the baby lost meconium with some plugs.
Annotated images denotes the low bowel obstruction and the transition zone as well as the saw-tooth appearance.
Case Discussion
These features are typical of long segment Hirschsprung disease.
Rectosigmoid ratio can applied only for the short segment Hirschsprung disease.
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