PEDIATRICS
DIAGNOSIS
■ Barium enema may demonstrate a cone-shaped transition zonebetween
the dilated proximal bowel and the abnormally contracted distal bowel.
■ Anorectal manometry
■ Rectal suction biopsy (gold standard)
TREATMENT
■ Patients who are suspected of having Hirschsprung disease with entero-
colitis or who have evidence of colonic obstruction should receive:
■ IV fluid
■ IV antibiotics
■ NG tube
■ Rectal tube
■ Emergent surgical consultation
COMPLICATIONS
■ Failure to thrive
■ Constipation
■ Enterocolitis
Acquired Disorders
PYLORICSTENOSIS
Pyloric stenosis is the most common cause of gastric obstruction in infants.
Typically, infants present with symptoms at 3–4 weeks of life, but may occur
anytime up to 5 months of age. Because neonates do not develop symptoms
until they are at least a week old, this condition is not thought to be truly con-
genital. The etiology of pyloric stenosis is unknown, but the end result is
hypertrophy of the pyloric muscle with resulting gastric outlet obstruction.
The incidence is roughly 1 in 500 live births, with males affected more than
females (4:1). Caucasians are affected more than other groups, with an
increased incidence in families.
SYMPTOMS
■ Nonbilious, projectile vomiting that typically occurs after feedings
■ Affected infants have a vigorous suck and appear hungry.
EXAM
Up to 90% of affected infants have a palpable mass (“olive”) in the RUQ,
although this finding may be difficult to elicit in an agitated infant.
DIAGNOSIS
■ If the RUQ mass is detected, no imaging is indicated and surgical consul-
tation should be obtained.
■ If the diagnosis is less certain, an ultrasound should be obtained. Pyloric
stenosis is confirmed if the ultrasound reveals a pylorus >4 mm thick and
longer than 16 mm.
■ If ultrasound is not available, an upper GI series will reveal a narrowed
pylorus (“tram-track sign”).