Daughter and mother diagnosed with hereditary multiple exostoses: A case report and a review of the literature

An Unusual Presentation of Bony Outgrowths on the Chest: A Case from Pakistan

We present a case of hereditary multiple exostoses in a male child, who presented to us with bony outgrowths on the chest and recurrent respiratory infections. On questioning, it was revealed that the child had a family history of bony outgrowths, though those affected in his family were not symptomatic. Other causes of recurrent respiratory infections were systematically ruled out, which led us to our conclusion. The treatment of this condition can be either conservative or surgical, but owing to the seriousness of our patient's condition, the preferred option was surgery in this case.

Atypical onset of total colonic Hirschsprung disease in a small female infant: A case report

RATIONALE

Hirschsprung disease (HD) or colonic aganglionosis is a congenital disorder, which results from the abnormal migration of neuronal cells of the neural crest leading to a disorder of the enteric nervous system consisting in the absence of ganglion cells within the submucosal and myenteric plexus.

PATIENT CONCERNS

We report the case of a 7-month-old female infant admitted in our clinic for constipation and failure to thrive. At the age of 6 months, she was examined in our clinic for the same reasons, and we recommended symptomatic treatment without improvements. The clinical examination revealed pallor of the skin and mucosa, distended abdomen, and abdominal tenderness at palpation.

DIAGNOSES

The abdominal ultrasound showed abdominal bloating, and the barium enema was normal. The patient's evolution worsened progressively within the following 3 days after admission associating sings of toxic megacolon.

INTERVENTIONS

She underwent a surgical intervention with total colectomy and ileostomy, and the final diagnosis confirmed by the histological examination was of total colonic aganglionosis (TCA).

OUTCOMES

The evolution immediately after the surgery and the follow-up examination after approximately 3 months pointed out normal weight gain and the laboratory tests were within normal limits.

LESSONS

TCA can also manifest in older infants. Barium enemas can guide the diagnosis in most cases of HD. Nevertheless, in patients with TCA, it can be normal. Moreover, it could represent a trigger for toxic megacolon.