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Case#1
3yofemale patient
History
• Constipation since birth• Failure tothrive• Noother associated conditions
AbdominalPictures
AbdominalX-rayuponarrival
Whatwouldyoudofirst(afterrectaldigitalexamination)?
1. Contrast enema2. Rectalirrigation3. Rectalbiopsy4. Idon’t know
• Enemawasperformed fordisimpaction
• Examination under anesthesia with rectalbiopsy
• Foundan analstenosis (Hegar 12only)
• Contrast enema
What would you donext?1. Constipation Managementwith laxatives2. Constipation Managementwith enemas3. Pullthrough forHirschsprung4. Colostomy5. MRI6. Idon’t know
• MRI– what doyou see?
Whatdoyourecommend?
1.Colostomy2.Primary pullthrough andpresacral massresection3.Spinal MRI4.Urologyconsult