Should we look for Hirschsprung disease in all children with meconium plug syndrome?

Rare presentation and retrograde diagnosis of total colonic aganglionosis in a female infant: a case report

BACKGROUND

Total colonic aganglionosis is an extremely rare variant of Hirschsprung's disease, which is predominant in males and can be seen in 1:50,000 live births. The presented case not only depicts a rare case, but also unusual clinical, laboratory, and instrumental data.

CASE PRESENTATION

A 2-day-old Caucasian female newborn was transferred to our hospital from maternity. The initial presentation was reverse peristalsis, abdominal distention, and inability to pass stool. Fever had started before the patient was transferred. Hirschsprung's disease was suspected, and tests such as contrast enema and rectal suction biopsy were done. Before enterostomy, the management of the disease included fluid resuscitation, colonic irrigation, antibiotic administration, enteral feeding, and supportive therapy. During ileostomy operation, no transition zone was visualized and full-thickness biopsy samples were retrieved from the rectum and descending colon. After surgical intervention, status significantly improved-defervescence and weight gain most importantly improved.

CONCLUSION

It is well known that diagnosis of total colonic aganglionosis may be delayed for months or even years since the transition zone may not be visible and rectal suction biopsy, unlike full-thickness biopsy, is not always reliable. It might be more prudent not to be derailed because of negative radiography and rectal suction biopsy. Also, doctors should be more suspicious of the disease if signs and symptoms are starting to be consistent with Hirschsprung-associated enterocolitis, despite biopsy and radiology results.

Bilious Emesis and Failure to Pass Meconium in the Nursery: A Case Study

We present a case of an infant born to a mother with COVID-19, who at 24 hours of life was treated with a glycerin suppository for failure to pass meconium and went on to develop bilious emesis and abdominal distention as feeding continued over the next several hours. After a barium enema identified the distal obstruction, the pediatric surgical team used rectal irrigation to remove a large meconium plug, which mimicked the appearance of the descending colon on plain film, in a case of small left colon syndrome. Although intestinal obstruction in the newborn is rare, it is imperative that it is promptly diagnosed and treated appropriately to avoid negative outcomes; which, even in perhaps the mildest form of functional distal obstruction, meconium plug syndrome, can lead to an impressive clinical illness with risk of intestinal perforation and subsequent meconium peritonitis if the obstruction is not relieved.

Five culturally protected water body practices in Fiji: Current status and contemporary displacement challenges

Community-based natural resource management in Oceania has its roots in culturally protected water body (CPWB) practices. However, CPWBs in Fiji have been under-researched regarding what practices exist, and the extent to which they are currently practiced. Archival research and interviews with 201 individuals across Fiji's 189 districts revealed five CPWB types. Conception, Meconium, and Circumcision CPWBs are at risk of practice cessation, while Chiefly investiture and Funerary, have 15% and 42% actively practicing districts, respectively. Primarily serving a ceremonial and food provisioning service, the view that CPWBs do not contribute to biodiversity conservation can be counterproductive to conservation efforts. CPWBs as a place-based practice are eroding due to low awareness by conservation practitioners, and exclusion from community management plans. Knowledge of CPWBs and the practical challenges of implementing them can help conservation practitioners and Indigenous peoples maintain cultural practices, while ensuring food security and conservation into the future.