Case+4+-+Constipation+and+Distention

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Quick and dirty.

Morning rounds today with overnight admission of 8 y/o male with complaint of 5 days of no BM with abdominal bloating and pain.

Although this particular episode was the reason for this admission, a careful medical student history revealed that the child has had problems with constipation for over 2 years. He has monthly episodes with no BM for 3-4 days, sometimes more, however he has never gone as long as this current 5 days. Mother states significant weight loss with poor appetite during this time period as well, with occasional low grade fevers. She denies any overt night sweats. No vomiting has been observed.

PMHx: none known. Fully vaccinated Surg Hx: none

Social history: Lives with 4 siblings and both parents. Parents are subsistence farmers. Child in standard 2, has been progressing through the grades however with occasional absence due to family inability to pay school fees.

Vitals: Temp 37.0 P 110/70 P 110 O2 98% RR 25 Gen: Chronically ill appearing, malnourished child, however in no acute distress. HEENT: sclera anicteric, mmm, no oral lesions Neck: no LAD, no palpable masses Pulm: mild tachypnea noted, with absent breath sounds in low right base. Otherwise clear to auscultation b/l CV: nl S1 and S2, no m/r/g. RRR Abd: grossly distended, though soft. Minimal but present bowel sounds. Diffuse tenderness to palpation but no rebound tenderness. No fluid wave noted. Unable to palpate organomegaly due to massive distention. Ext: no peripheral edema, no clubbing noted.

FBC: Hgb 10.2, WBC 5, Plts 300

Abdominal Xray:



How do you read the xrays?

Any further laboratory tests you’d like to obtain?

What are the potential diagnoses?