Chronic constipation, which may be habitually or pathologically caused, is one of the most common complaints in children. One of the important pathological causes is Hirschsprung's disease (HD), which is diagnosed via multiple modalities, mainly rectal biopsy. Our aim was to compare the presentation and different predictive factors for positive rectal biopsy results in a developing country in the Middle East, such as Jordan. This cohort study was conducted at the Jordan University Hospital (JUH). All consecutive children aged <14 years who presented with refractory constipation and underwent rectal biopsies between January 2014 and December 2019 were retrospectively enrolled in the study. In the entire cohort study, 79 patients were enrolled: 45 (57%) were males and 34 (43%) were females. Regarding the biopsy results, 51 (64.6%) cases of refractory constipation without HD and 28 (35.4%) patients with refractory constipation with HD were diagnosed with open rectal biopsies. The male-to-female ratio of HD patients was 3:1. Moreover, 3 (10.7%) children who passed the meconium within the first 24 to 48 hours showed features of HD, while 17 (60.7%) children with delayed passage of the meconium showed features of HD. Abdominal distension was found to be a positive predictor of positive biopsy results (odds ratio [OR] = 4.09, P = .011), and soiling was found to be a negative predictor of positive biopsy results (OR = 0.07, P = .024). In developing countries, children presenting with HD seem to have similar symptoms and signs to those observed with traditional sampling and staining techniques.
Introduction Abdominal wall endometriosis (AWE) is an understudied entity in which many women of childbearing age who have undergone pelvic obstetric surgeries suffer. In this series, we will present three cases of AWE and discuss the diagnostic challenge in this uncommon disease. Presentation of cases These case series describe the different presentations of the entity and the various methods of diagnosing them. Many other reviews have discussed the possible preventative methods to decrease the chances of developing abdominal wall endometrioma. Discussion Women of childbearing age, with a previous C-section or hysterectomy, who present with chronic abdominal pain and bulging related to their wound should raise the suspicion and further go an abdomen pelvic CT scan at the time of menstruation. Diagnosis of abdominal wall endometriomas is usually delayed, as symptoms are non-specific, cyclical, and slowly progressive. After imaging, the patient must undergo surgical excisional biopsy to have a definitive diagnosis. Conclusion Abdominal wall endometriomas are only visualized on a CT scan during menstruation, increasing the challenge of diagnosing this entity significantly. To minimize the error in diagnosis, a raised suspicion of this pathology is the key to identifying this issue.
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