Case contributed by Dr Ian Bickle


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

Patient Data

Age: 14
Gender: Female

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

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

No proximal bowel obstruction.

Her original problem - a mandibular ameloblastoma is illustrated.


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

Biopsy proven ameloblastoma.


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
Published: 2nd Jul 2015
Last edited: 15th Jan 2020
Tag: ravi
Inclusion in quiz mode: Included

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