Patient Case Discussion
Case Summary
OVERVIEW
The was a case of a 9-year-old male, previously healthy, but with a history of constipation who recently immigrated from Africa. The diagnostic procedures and decision-making process involved in the case were discussed. The surgical team emphasized the importance of thorough diagnostic procedures, including lateral views during contrast enemas, and the significance of hypertrophic nerves in biopsy results in biopsy results, noting that they are common in chronic idiopathic constipation and may not be a definitive indicator of Hirschsprung disease. The case was enrolled in a bowel management program after the biopsy came back negative for Hirschsprung disease.
Hypertrophic Nerves in Chronic Constipation Diagnosis
Concerns were raised about the significance of hypertrophic nerves in the diagnosis of certain conditions, suggesting that they may not hold as much weight as previously thought. Hypertrophic nerves are a common finding in patients with chronic idiopathic constipation. The patient's post-operative course was initially uneventful, but they later experienced enterocolitis and dilatation of the transverse colon. Despite treatment, the patient's condition did not improve significantly, leading to further discussions about potential next steps.
Next Steps
1. Follow up with the patient to ensure continued improvement in bowel movements and adherence to the bowel management program.
2. Research team to review literature on the significance of hypertrophic nerves in chronic constipation and Hirschsprung disease.
3. Radiology team to ensure lateral views are consistently included in contrast enema studies for suspected Hirschsprung disease cases.
4. Medical team to reassess the diagnostic value of hypertrophic nerves in pathology reports for constipation and Hirschsprung's disease cases.
5. Continue teaching the transanal open biopsy technique to ensure proper identification of the dentate line and accurate biopsy placement.
6. Pediatric surgery team to perform transanal pull-through with leveling biopsies approximately 6 weeks after patient's discharge.