Megarectum

Case contributed by Dr Ian Bickle

Presentation

14 year old female in theatre under GA performed for mandibular resection. Noted to have a pelvic mass.

Patient Data

Age: 14
Gender: Female
CT

The rectum to the rectosigmoid junction is massively distended measuring 11cm in axial diameter, and is occupied by a large volume of impacted faeces.

The bladder and uterus are displaced by the faeculant filled rectum.

No proximal bowel obstruction.

Her original problem - a mandibular ameloblastoma is illustrated.

CT

Expansile lesion with cortical destruction in the body of the left mandible with an associated unerupted tooth.

Biopsy proven ameloblastoma.

Photo

Site of mandibular ameloblastoma

Case Discussion

Hirschsprung disease is the most common cause of neonatal colonic obstruction. It accounts for ~15-20% of all intestinal obstructions in the neonate.  It can present later in life, as in this perceived case.

The main differential is a functional megarectum.

In this case it only came to light due to the dutiful examination of a maxillofacial surgeon, just prior to performing a mandibular resection for an ameloblastoma.

Retrospective questioning indicated the patient has not emptied her bowel for 3 months!

The patient/patient guardian declined rectal biopsy to confirm the strong suspicion of late presentation Hirschsprung's disease.

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Case information

rID: 37485
Case created: 10th Jun 2015
Last edited: 1st Aug 2017
Tag: ravi
Inclusion in quiz mode: Included

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