PMC5653242_01
(A) Barium enema showed relatively normal caliber colon and rectum. (B) Small bowel series showed faint lining of rectum and descending colon wall on delayed images, suggesting partial obstruction at distal small bowel.
gr1.jpg
PMC5653242_01_gr1.jpg
fig0005
Contrast enema showed a normal caliber colon without a transition zone in the colon or the rectum and a small bowel series demonstrated a partial mechanical obstruction near the terminal ileum (Fig. 1A, B).
Transition zone is noted at 30 cm proximal to the ileocecal valve.
gr2.jpg
PMC5653242_01_gr2.jpg
fig0010
On laparotomy, there were no obstructing lesions identified at the terminal ileum but a transition zone was identified 30 cm proximal to the ileocecal valve (Fig. 2), thus suggesting TCA with involvement of the terminal ileum.
There were no identifiable ganglion cells on permanent section of the appendix (H&E, x200).
gr3.jpg
PMC5653242_01_gr3.jpg
fig0015
TCA was suspected (Fig. 3). The postoperative course was uneventful and the patient is currently awaiting a definitive pull-through operation.