A 4 year old boy presents with a history of constipation

Discussion in 'MRCS Forum' started by Lona., Nov 3, 2007.

  1. Lona.

    Lona. Guest

    A 4 year old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone, and stool in the rectal vault. The most likely diagnosis is -
    a- Hirschsprung’s disease
    b- Functional constipation
    c- Hypercalcaemia
    d- Intestinal obstruction
    e- Hypothyroidism
  2. Lona.

    Lona. Guest

    The answer is B. (Behrman 15/e, pp 1034-1035, 1070-1072) Hirschsprung’s disease is usually suspected in the chronically constipation child despite the fact that 98 percent o such children have functional constipation. Finding a dilated, stool-filled anal canal with poor tone on the physical examination of a well-grown child supports the diagnosis of functional constipation. The difficulty in treating functional constipation once it has been established emphasizes the need or prompt identification and treatment of problems with defecation and for counselling of parents regarding proper toileting behaviour.

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