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