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Chapter 37

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1. Hirschsprung disease

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Figure 37-1

Hirschsprung disease.

An upright radiograph of a neonate with marked abdominal distension demonstrates air-fluid levels in multiple dilated loops of colon and small intestine. There is a paucity of gas in the rectum.

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2. Hirschsprung disease

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Figure 37-2

Hirschsprung disease.

An abdominal radiograph of a 3-day-old infant with a history of vomiting, abdominal distension, and failure to pass meconium demonstrates dilation of gas-filled colon and small bowel. There is no visible gas in the rectum.

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3. Hirschsprung disease

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Figure 37-3

Hirschsprung disease.

A lateral image obtained early during filling of the colon with barium shows a tubular configuration of the rectum and a relatively abrupt transition to a dilated sigmoid colon. The rectosigmoid ratio is 0.5. A normal posterior outpouching at the anorectal sling is lacking. There are thin circular folds in the rectum, due to contractions.

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4. Hirschsprung disease

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Figure 37-4

Hirschsprung disease.

There are various types of colonic contractions in this infant with rectosigmoid and distal descending colon Hirschsprung disease. Some contractions are deep and irregular, others broad, and some are fine and circumferential.

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5. Hirschsprung disease

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Figure 37-5

Hirschsprung disease.

There are multiple thin transverse folds in the rectum in this infant with low-segment Hirschsprung disease. There is slight narrowing of the inferior aspect of the rectum. The normal anorectal sling impression is lacking.

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6. Short-segment Hirschsprung disease

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Figure 37-6

Short-segment Hirschsprung disease.

Barium examination shows narrowing and irregular contractions of the rectum and distal portion of the colon. There is dilation of the colon proximal to the transition zone in the sigmoid.

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7. Endorectal pull-through

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Figure 37-7

Endorectal pull-through.

An axial MR image shows the rectum (white arrow) passing somewhat asymmetrically through the thin puborectalis muscle sling (black arrows). Hyperintense perirectal fat partially surrounds the rectum.

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8. Meconium plug syndrome

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Figure 37-8

Meconium plug syndrome.

A contrast enema of a neonate with abdominal distension shows filling defects in the descending and rectosigmoid portions of the colon. The caliber of the colon is normal. There are moderately dilated gas-filled loops of intestine proximally.

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