Hirschsprung

Case contributed by Dr Jeremy Jones

Presentation

Failure to pass meconium. Abdominal distension.

Patient Data

Age: 2 days (term)
Gender: Male
X-ray

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.

Fluoroscopy

Reversal of the normal rectosigmoid ratio. Dilated transverse and descending colon. Appearances 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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Case information

rID: 62788
Published: 29th Aug 2018
Last edited: 26th Jan 2019
System: Paediatrics
Inclusion in quiz mode: Included
Institution: NHS Lothian

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