Emerg Med J 30:343 doi:10.1136/emermed-2012-201635
  • Images in emergency medicine

Another case of diarrhoea in a 7-year old

  1. Daniel A Thimann2
  1. 1Department of Pediatrics, Division of General Pediatrics, Children's Medical Center, Dallas, Texas, USA
  2. 2Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Daniel A Thimann, Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75225, USA; daniel.thimann{at}
  1. Contributors Dr EW and Dr DT are the authors of this paper.

  • Accepted 11 June 2012
  • Published Online First 3 July 2012

A 7-year-old female with a history of Trisomy 21 and Hirschsprung disease status, post-surgical repair, presents to the Emergency Department with a history of six episodes of copious green watery diarrhoea for one day. She has been afebrile and has had decrease in urine output. Upon presentation to the ED, she was found to be lethargic and ill-appearing. She had clinical signs of dehydration, including: tachycardia, dry mucous membranes, delayed capillary refill and mottled skin. She responded well to fluid resuscitation. A KUB was obtained which demonstrated a dilated colon (figures 1 and 2).

Figure 1

KUB showing dilation of the transverse and descending colon.

Figure 2

KUB showing air fluid levels.

The diagnosis of megacolon, with possible enterocolitis, was made. Hirschsprung disease is commonly associated with Trisomy 21. In some cases, surgical repair of Hirschsprung disease is curative, but some may develop late post-operative complications, including obstruction, incontinence and enterocolitis. Megacolon can be seen in patients presenting with obstruction secondary to Hirschsprung disease. Enterocolitis may be associated with inflammatory bowel disease and C. difficile infections. Clinical features of enterocolitis include fever, abdominal distension and diarrhoea. Treatment is generally non-surgical and includes decompression of the rectum, rectal irrigation and broad-spectrum antibiotics.1 Past medical history is important in establishing a differential diagnosis even in pediatric patients.


  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.


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