Case contributed by Jeremy Jones


Failure to pass meconium. Abdominal distension.

Patient Data

Age: 2 days (term)
Gender: Male

Multiple gas-filled loops of bowel. It is often difficult to tell small and large bowel from each other. In this case, the colon is clearly seen as the most dilated set of loops. No mural, free or portal-venous gas.


Reversal of the normal rectosigmoid ratio. Dilated transverse and descending colon. Appearances are consistent with Hirschsprung disease.

Case Discussion

The reversal of the rectosigmoid ratio is the key to diagnosis here. It is vital to always start in the lateral position and to not insert the catheter too far and never inflate a balloon until you have ensured the diagnosis.

Appearances here are of Hirschsprung disease which was confirmed on a punch biopsy. 

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