Patient Case Discussion
Case Summary
OVERVIEW
This is the case of a 7-year-old female with a lifelong history of constipation who presented to the emergency department after undergoing a contrast enema. The patient was admitted, started on irrigations, and underwent a rectal biopsy, which demonstrated no ganglion cells, consistent with Hirschsprung' disease. The team discussed the management of the patient, with options including a diverting stoma or a plan for a delayed pull-through.
Hirschsprung Disease Management in Children
The patient had not passed flatus or had a bowel movement since the procedure. A contrast enema showed significant gaseous and liquid distention of the colon. The patient was admitted, started on irrigations, and underwent a rectal biopsy, which demonstrated no ganglion cells, consistent with Hirschsprung disease. The patient was discharged home on rectal irrigations and prophylactic flagyl, with plans for a pull-through procedure in a few months. The team discussed the management of the patient, with options including a diverting stoma or a plan for a delayed pull-through.
Next Steps
1. Pediatric surgery team to perform transanal pull-through with leveling biopsies approximately 6 weeks after patient's discharge.
2. Medical team to continue patient's discharge plan of rectal irrigations 3 times daily and oral flagyl.
3. Pediatric surgery team to conduct weekly follow-up appointments with the patient, including abdominal X-rays.
4. Medical team to review and improve early diagnosis protocols for Hirschsprung's disease to prevent late diagnoses in the future.
5. Radiology department to establish a protocol for immediate communication of concerning findings to relevant medical teams.Schedule a pull-through procedure for the patient once her nutritional status has improved.