Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a long-standing history of chronic, refractory constipation since childhood, requiring chronic laxative use or manual disimpaction. Reports abdominal distension, intermittent cramping, and infrequent bowel movements (less than 3 per week). Denies alarm symptoms such as hematochezia or unintentional weight loss. No history of prior surgical intervention for colonic pathology.
Clinical Examination Findings
Abdomen: Distended, tympanitic to percussion, non-tender to palpation. Digital Rectal Exam (DRE): Empty rectal vault, tight anal sphincter, absence of fecal material in the ampulla. Withdrawal of finger may result in an explosive release of gas and liquid stool (Blast sign). Bowel sounds: Normoactive to hyperactive.
Treatment Protocol
Plan: 1. Diagnostic confirmation via anorectal manometry and full-thickness rectal biopsy (gold standard for ganglion cell absence). 2. Bowel regimen optimization (osmotic laxatives, fiber supplementation). 3. Surgical consultation for definitive management (e.g., Duhamel, Swenson, or Soave pull-through procedure). 4. Monitor for complications including enterocolitis.