Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of failure to pass meconium within the first 48 hours of life. Current symptoms include chronic constipation, abdominal distension, and episodes of bilious emesis. Failure to thrive and poor feeding noted. No improvement with laxatives or dietary modifications.
Clinical Examination Findings
Abdominal examination reveals significant distension with visible bowel loops. Rectal examination demonstrates an empty rectal vault on digital exam, with a positive "squirt sign" or explosive expulsion of stool and gas upon withdrawal of the finger. Anal sphincter tone is hypertonic.
Treatment Protocol
Surgical consultation requested for definitive management. Initial stabilization includes bowel decompression via rectal irrigation or nasogastric tube. Planned surgical intervention involves pull-through procedure (e.g., Swenson, Duhamel, or Soave) to excise the aganglionic segment. Post-operative monitoring for enterocolitis is mandatory.