Differentials
Meconium-plug syndrome
SIGNS / SYMPTOMS
The expulsion of a plug of meconium with resolution of symptoms and the absence of other signs characteristic of Hirschsprung disease help establish the diagnosis.
INVESTIGATIONS
Contrast enema can be both diagnostic and therapeutic.
Air mixed with meconium shows up as a soap bubble or calcification-like appearance on radiographs.
Cystic fibrosis (meconium ileus)
SIGNS / SYMPTOMS
Manifested by a clinical picture consistent with intestinal obstruction, with the child frequently exhibiting respiratory symptoms.
A family history of cystic fibrosis may be noted.
INVESTIGATIONS
The absence of air-fluid levels in an upright abdominal film and the ground-glass appearance of the lower abdomen are characteristic radiographic signs. The contrast enema shows a microcolon or a nondilated one.
Small left colon syndrome
SIGNS / SYMPTOMS
Symptoms usually improve following contrast enema and resolve after several weeks.
Frequently occurs in infants of mothers with diabetes mellitus.
INVESTIGATIONS
Contrast enema demonstrates a narrow left colon to the level of the splenic flexure.
Hypothyroidism
SIGNS / SYMPTOMS
Colonic ileus and abdominal distension.
The abdominal distension will accompany bradycardia, feeding difficulties, and other signs associated with hypothyroidism.
INVESTIGATIONS
TSH is elevated in primary hypothyroidism.
Cerebral injury
SIGNS / SYMPTOMS
Colonic ileus and abdominal distension.
A history of birth-related head injuries should raise suspicion of this cause of ileus.
INVESTIGATIONS
Diagnosis is clinical.
Chronic constipation
SIGNS / SYMPTOMS
The colon is dilated and full of fecal material all the way down to the anal canal.
Children usually become symptomatic after the sixth month of life; they neither vomit nor become seriously sick.
Eventually, children develop overflow incontinence or encopresis: a constant, chronic soiling without evidence of neuromuscular disturbance.
The rectum is impacted with stool.
INVESTIGATIONS
Rectal examination in these children reveals a severe fecal impaction just above the anal canal.
Contrast enema shows a reverse pattern of dilation. In idiopathic constipation, the rectosigmoid is enormous and the proximal colon may have a normal caliber.
Distal small bowel atresia or stenosis
SIGNS / SYMPTOMS
Abdominal distension and bilious vomiting.
INVESTIGATIONS
Plain x-ray often shows evidence of an intestinal atresia.
Contrast enema will show a microcolon.
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