Hirschsprung´s Disease vs. Ileus of Small Intestine
Left picture: An ileus of the newborn is present due to Hirschsprung´s disease. Right picture: In this case the cause of the neonatal obstructive ileus is an intestinal duplication. The picture at the bottom shows the pathology: The structure which lies close to the small intestine on the mesenterial side on the left side of the surgeon´s hand, has filled up gradually with air and secretions and compromised the passage of the small intestine by a valve mechanism at this site (see picture at the bottom of the same patient). Left picture: Although the number and the distribution of the air-fluid levels is not specific for a special pathology and allows only a gross localization of the site of obstruction of the gastrointestinal tract, when considering the described findings, no other pathology is suitable than a Hirschsprung´s disease as cause of a low obstructive ileus, above all, if an anorectal malformation as an imperforate anus without fistula or rectal atresia has already been clinically excluded. Right picture: Here, different causes of an ileus are possible. Because not the whole abdomen is filled with air-fluid levels and because there are multiple levels an ileus at a middle level must be present, most probably an ileus of the small intestine. In case of high ileus only few air-fluif levels are recognizable.
In both neonates a plain x-ray in upright position has been performed due to suspected obstructive ileus. Both patients have multiple abdominal air-fluid levels of different size. Left picture: The air-fluid levels are distributed across the whole abdomen. Right picture: Here, there are only air-fluid levels in the left upper and whole middle belly. Left picture: In addition, intestinal loops are visible which are conspicuously filled up with air.