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HEAPHY 1 & 2 CASE RACE 1 – DIAG Heather GUNN

Sat 31 st Aug 2013 Session 3 / CR1-1 13:01 – 13:05. HEAPHY 1 & 2 CASE RACE 1 – DIAG Heather GUNN. AUCKLAND ABSTRACT Auckland will present an interesting case of late diagnosis (diagnosis withheld). Case Race . Delayed diagnosis HG. Patient. Age : 29 years (at first presentation)

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HEAPHY 1 & 2 CASE RACE 1 – DIAG Heather GUNN

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  1. Sat 31stAug 2013 Session 3 / CR1-1 13:01 – 13:05 HEAPHY 1 & 2 CASE RACE 1 – DIAG Heather GUNN AUCKLAND ABSTRACT Auckland will present an interesting case of late diagnosis (diagnosis withheld)

  2. Case Race Delayed diagnosis HG

  3. Patient • Age : 29 years (at first presentation) • Gender : Male • History : • Childhood abuse • Mental impairment • Bowel problems since childhood

  4. 17/04/12 Soiling ? Bowel obstruction Report: Marked faecal loading – no obstruction

  5. 16/06/2012 (two months later) Long history of bowel problems Report: Significant faecal loading along with gaseous distension. No free air

  6. 25/01/2013 (nine months later) Diahorrhea and vomiting over last 24 hrs Report: Severe faecal loading distal sigmoid and rectum Consider Hirschsprung disease

  7. 22/05/13 (one year and one month later) Vomiting pain and distension Report: Progressive distension of sigmoid filled with faecal matter Findings in keeping with Hirschsprung disease

  8. Usually diagnosed when the newborn fails to pass meconium - usually within 48 hours of birth He was diagnosed at 30 years http://www.beltina.org/pics/hirschsprungs_disease.jpg

  9. Treatment • Surgery – most commonly: • Colostomy • Aganglionic section removed (if possible) • Bowel pulled through and anastomosed to e.g. anus • Healing • Colostomy reversed

  10. Our Patient • CT yesterday (29th August) showed a narrowing 2.5cm above anal margin • Patient is refusing biopsy • Patient not keen on surgery

  11. End

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