Megarectum

Case contributed by Dr Ian Bickle

Presentation

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

Patient Data

Age: 14
Gender: Female
Modality: 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.

Modality: CT

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

Biopsy proven ameloblastoma.

Modality: 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: 9th Oct 2015
Tag: ravi
Inclusion in quiz mode: Included

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