A 50-Hour-Old Boy Is in the Nursery with Several Episodes

question 580

Multiple Choice

A 50-hour-old boy is in the nursery with several episodes of bilious emesis.  He is unable to tolerate breast or bottle feeds.  He has urinated twice but has not passed meconium.  The boy was born to a primigravid woman at 39 weeks gestation; birth was by cesarean section due to failure to progress.  The pregnancy was uncomplicated and prenatal laboratory results were normal.  The mother declined genetic testing during the pregnancy.  Membranes ruptured spontaneously 2 hours before delivery and the fluid was clear.  Apgar scores were 9 at both 1 and 5 minutes.  Weight, length, and head circumference are average for gestational age.  Examination shows a non-dysmorphic boy with a markedly distended abdomen.  The anus is open and normally positioned.  No stool is palpable in the rectal vault.  A nasogastric tube is placed for decompression and intravenous fluids are initiated.  Abdominal x-ray shows multiple dilated loops of large bowel and no air in the rectum.  Contrast enema shows a normal caliber rectosigmoid colon and a dilated descending colon.  Which of the following is the best test to confirm the underlying diagnosis?

• A)Abdominal ultrasound
• B)Anorectal manometry
• C)Rectal suction biopsy
• D)Sweat chloride test
• E)Upper gastrointestinal series

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