Mr. and Ms. Byers’ child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following?
A. Celiac disease
B. Intussusception
C. Hirschsprung’s disease
D. Abdominal-wall defect
Correct Answer: C. Hirschsprung’s disease
Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung’s disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. History of the colonic obstruction, which might occur during the early neonatal period till adulthood, along with failure to pass meconium during the first 48 hours of the life, which presents in up to 90% of the affected patients, is highly compatible with the impression of HD.
Option A: Celiac disease, also known as gluten-sensitive enteropathy, is an autoimmune disease of the small intestine. Celiac disease is a condition in which the body responds to gluten with an inappropriate immune response causing small intestinal inflammation and damage.
Option B: Intussusception is a condition in which part of the intestine folds into the section next to it. Intussusception usually involves the small bowel and rarely the large bowel. Symptoms include abdominal pain which may wax and wane, vomiting, bloating, and bloody stool.
Option D: Failure to pass meconium is not connected with abdominal wall defect. Gastroschisis is a paraumbilical abdominal wall defect associated with protrusion of the bowel through the defect. A membrane does not cover the bowel exposed in utero and, as a result, may be matted, dilated, and covered with a fibrinous inflammatory rind.