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Patient Age : 29 years (at first presentation) Gender : Male History : – Childhood abuse – Mental impairment – Bowel problems since childhood
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HEAPHY 1 & 2CASE RACE 1 – DIAG
Heather GUNN
Sat 31st Aug 2013Session 3 / CR1-1
13:01 – 13:05
AUCKLAND
ABSTRACTAuckland will present an interesting case of late diagnosis (diagnosis
withheld)
Case Race
Delayed diagnosis
HG
Patient• Age : 29 years (at first presentation)• Gender : Male• History :
– Childhood abuse– Mental impairment – Bowel problems since childhood
17/04/12
Soiling? Bowel obstruction
Report:
Marked faecal loading – no obstruction
16/06/2012(two months later)
Long history of bowel problems
Report:Significant faecal loading along with gaseous distension.
No free air
25/01/2013 (nine months later)
Diahorrhea and vomiting over last 24 hrs
Report:Severe faecal loading distal sigmoid and rectum
Consider Hirschsprung disease
22/05/13(one year and one month later)
Vomiting pain and distension
Report:Progressive distension of sigmoid filled with faecal matter
Findings in keeping with Hirschsprung disease
http://www.beltina.org/pics/hirschsprungs_disease.jpg
Usually diagnosed when the newborn fails to pass meconium - usually within 48 hours of birthHe was diagnosed at 30 years
Treatment• Surgery – most commonly:
– Colostomy– Aganglionic section removed (if
possible)– Bowel pulled through and anastomosed
to e.g. anus– Healing– Colostomy reversed
Our Patient• CT yesterday (29th August) showed a
narrowing 2.5cm above anal margin• Patient is refusing biopsy• Patient not keen on surgery
End