Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a lifelong history of chronic, refractory constipation, requiring daily laxatives or manual disimpaction. Reports abdominal distension, intermittent episodes of paradoxical diarrhea, and failure to thrive or delayed growth in childhood. No history of surgical correction in infancy. Current symptoms include severe bloating, early satiety, and episodic fecal impaction.
Clinical Examination Findings
Abdominal examination reveals significant distension with tympany on percussion. Peristaltic waves may be visible. Digital Rectal Examination (DRE) demonstrates an empty rectal vault, tight anal sphincter, and a positive "squirt sign" or explosive expulsion of gas and stool upon withdrawal of the examining finger. Signs of fecal loading in the left lower quadrant are noted on palpation.
Treatment Protocol
Management plan includes bowel regimen optimization with osmotic laxatives and stool softeners. Referral for anorectal manometry and contrast enema to confirm transition zone. Surgical consultation for definitive management, typically involving pull-through procedures (e.g., Duhamel, Soave, or Swenson technique) to resect the aganglionic segment. Long-term monitoring for enterocolitis and bowel function recovery.