Patient Case Discussion
Case Summary
OVERVIEW
Dr. Lauren Evans presented a case of a 7-year-old female with a lifelong history of constipation, who had undergone fecal disimpaction three times in the past couple of years. The treatment team discussed the use of irrigations for liquid stool, the importance of a rectal biopsy before a contrast enema, and the main treatment options for the patient's condition. The team also discussed the presence of stratified squamous epithelium in a biopsy report and the need to amend the report in the report in the medical chart.
Hirschsprung's Disease in a Young Girl
The patient presented with severe fecal impaction and stercal colitis and was admitted to the hospital. The patient's past medical history was notable for mild developmental delay and a history of oral aversion and picky eating. The patient was evaluated and a rectal biopsy was performed, which demonstrated no ganglion cells identified, suggesting Hirschsprung disease. The patient was started on irrigations and oral flagyl, and close follow-up was planned. The patient's malnutrition and poor oral intake were likely related to chronic smoldering enterocolitis. The patient showed significant improvement in appetite, oral intake, and weight gain, and the plan was to remove the NG tube and proceed with a pull-through at a later date.
Rectal Biopsy and Treatment Options
Discussed were the use of irrigations for liquid stool and the importance of a rectal biopsy before a contrast enema. Dr. Peña suggested a contrast enema to diagnose the condition and a biopsy to confirm it. The main treatment options were discussed, including a pull-through procedure, resection of the most dilated colon, and the possibility of a colostomy. Dr. De La Torre agreed with Dr. Peña's recommendations and emphasized the importance of a second opinion on the biopsy report. Also discussed was the presence of stratified squamous epithelium in a biopsy report and the need to amend the report in the medical chart.
Next Steps
1. Schedule a pull-through procedure for the patient once her nutritional status has improved.
2. Gastroenterology team to remove the NG tube at a subsequent appointment.
3. Continue monitoring the patient's weight gain and growth curve progress.
4. Follow up with the patient in the clinic to ensure resolution of enterocolitis and improvement in oral intake.
5. Pathology team to amend the original biopsy report to reflect the accurate findings from the second review.