Name three differentials for lower GI obstruction
Hirschprung disease Meconium plug syndrome Meconium ileus Ileal atresia Colonic atresia
Contrast was introduced into the rectum via a catheter. No contrast passed proximal to the sigmoid colon, and there was a abnormal tapering of the colon in the mid-sigmoid. No plugs were seen in the distal large bowel.
Despite multiple attempts to opacify the proximal large bowel, there was constant leakage of contrast and no proximal opacification.
An upper GI contrast study was performed at the same time and was normal.
At theatre the patient had a short segment atresia involving the distal descending and sigmoid colon. The segment was resected with an end to end anastomosis and de-functioning ileostomy. This was successfully reversed 6 weeks later.