ABSTRACT
A 2-year-old male with a history of chronic constipation since 1 year of age with failure to thrive presents to your clinic. Initially, his providers thought he had Hirschsprung disease (HD.) His contrast study was thought to be suspicious for this disease, but a full thickness rectal biopsy revealed ganglion cells and no hypertrophic nerves. Treatment prior to presenting to us included high doses of various stimulant laxatives, rectal irrigations, and three separate anal botulinum toxin injections with no significant improvement. The patient had a previous myectomy performed as well, which improved his symptoms temporarily but did not resolve them. His contrast study can be seen in Figures 19.1 and 19.2.
